Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Neurology (Impact Factor: 8.29). 06/2005; 64(12):2069-73. DOI: 10.1212/01.WNL.0000165987.89198.65
Source: PubMed


To examine the neuropsychological profile of dementia patients from a community-based autopsy sample of dementia, comparing Alzheimer disease (AD), Lewy body pathology (LBP) alone, and LBP with coexistent AD (AD/LBP).
The authors reviewed 135 subjects from a community-based study of dementia for whom autopsy and brain tissue was available. Diagnostic groups were determined according to standard neuropathologic methods and criteria, and the presence of LBs was determined using alpha-synuclein immunostaining. Neuropathologically defined diagnostic groups of AD, AD/LBP, and LBP were examined for differences on neuropsychological test performance at the time of initial study enrollment.
There were 48 patients with AD alone, 65 with LB and AD pathology (AD/LBP), and 22 with LBP alone (LBP alone). There were no significant differences between groups demographically or on performance of enrollment Mini-Mental State Examination (MMSE) or Dementia Rating Scale (DRS). AD patients performed worse than the LBP patients on memory measures (Fuld Object Memory Evaluation Delayed Recall, Wechsler Memory Scale Logical Memory Immediate and Delayed Recall; p < 0.05) and a naming task (Consortium to Establish a Registry for Alzheimer's Disease Naming; p < 0.05). LBP patients were more impaired than AD patients on executive function (Trail Making Test Part B; p < 0.05) and attention tasks (Wechsler Adult Intelligence Scale-Revised Digit Span; p < 0.05). Decline in MMSE and DRS scores over time were greatest in the patients with AD/LBP.
In a community-based sample of older, medically complicated patients with dementia, there are neuropsychological differences between dementia subtypes at the time of diagnosis. In particular, patients with Alzheimer disease (AD) alone and AD/Lewy body pathology (LBP) had more severe memory impairment than patients with LBP. LBP alone was associated with more severe executive dysfunction. Patients with AD/LBP had the most rapid rate of cognitive decline.

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    • "However, these findings are contrast the findings of Sahgal et al.[18] where the authors found that visual set-shifting abilities were equally impaired in both DLB and AD patients. Divided attention has been more specifically studied by Kraybill et al.,[50] who found that Part A of the TMT did not differ among groups, but DLB patients performed much more poorly on Part B of the TMT than did the AD patients. These findings suggested that LBP patients were actually more impaired in terms of divided attention and not overall just slow-performers due to their motor slowing. "
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