Motor and cognitive function in Lewy Body dementia: Comparison with Alzheimer's and Parkinson's disease

Department of Old Age Psychiatry, Withington Hospital, West Didsbury, Manchester, UK.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 04/1997; 62(3):243-52. DOI: 10.1136/jnnp.62.3.243
Source: PubMed


Motor and cognitive function were compared in patients with Lewy body dementia, Parkinson's disease, or Alzheimer's disease, to identify features that may be clinically useful in differentiating Lewy body dementia from Alzheimer's disease and Parkinson's disease.
A range of neuropsychological function and extrapyrimidal signs (EPS) was assessed in 16 patients with Lewy body dementia, 15 with Parkinson's disease, 25 with Alzheimer's disease, and 22 control subjects.
The severity of total motor disability scores increased in the following order: controls approximately = Alzheimer's disease < Parkinson's disease < Lewy body dementia. Compared with patients with Parkinson's disease, patients with Lewy body dementia had greater scores for rigidity and deficits in the finger tapping test, but rest tremor and left/right asymmetry in EPS were more evident in Parkinson's disease. Patients with Lewy body dementia were also less likely to present with left/right asymmetry in EPS at the onset of their parkinsonism. "Sensitivity" to neuroleptic drugs was noted in 33% of patients with Lewy body dementia. Alzheimer's disease and Lewy body dementia groups had greater severity of dementia compared with the Parkinson's disease group and controls. Neuropsychological evaluation disclosed severe but similar degrees of impaired performances in tests of attention (digit span), frontal lobe function (verbal fluency, category, and Nelson card sort test) and motor sequencing in both Lewy body dementia and Alzheimer's disease groups, than Parkinson's disease and controls. In the clock face test, improved performance was noted in the "copy" compared to "draw" part of the test in controls, patients with Alzheimer's disease, and those with Parkinson's disease, but not in the patients with Lewy body dementia, who achieved equally poor scores in both parts of the test.
EPS in Lewy body dementia resemble those seen in idiopathic Parkinson's disease, although less rest tremor and left/right asymmetry but more severe rigidity favours a diagnosis of Lewy body dementia. The unique profile of patients with Lewy body dementia seen in the clock face test suggests that this simple and easy to administer test may be useful in the clinical setting to differentiate Lewy body dementia and Alzheimer's disease.

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Available from: Kanna K Gnanalingham
    • "Visuo-spatial praxis is a general term given to all the cognitive abilities involved in constructional abilities several studies have documented impairment in visuo-spatial praxis in both AD and DLB.[15161937] Most investigators,[282138394041] have recorded greater visuo-spatial/constructional (and visual-perceptual) deficits in patients with DLB as compared with patients with AD. Walker et al.[42] demonstrated that patients with DLB performed worse than patients with AD who were similar in overall degree of cognitive impairment on the praxis subtest of the CAMCOG, including visuo-constructive tasks. "
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    • "Others showed that the Parkinsonian features in LBD are more severe than Alzheimer's disease and closely resemble Parkinson's disease (Louis et al, 1995; Gnanalingham et al, 1997). Other features, depression, delirium and halluci nations are not uncommon in dementia and are often seen in LBD. "
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