Can we identify prodromal dementia with <scp>Lewy</scp> bodies in late‐life depression?

Sekiguchi, Hirotaka; Fujishiro, Hiroshige; Torii, Youta; Iritani, Shuji; Ozaki, Norio

doi:10.1111/pcn.13187

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Many clinical case reports regarding patients with late-onset depression who converted to DLB were rapidly accumulating (Table 1). 17,18,[52][53][54][55][56][57][58][59] The disease duration until development of dementia tended to be longer when initial psychiatric symptoms appeared at younger ages.…”

Section: Late-onset Depressionmentioning

confidence: 99%

Clinical presentations and diagnostic application of proposed biomarkers in psychiatric‐onset prodromal dementia with Lewy bodies

Kobayashi,

Iwata‐Endo,

Fujishiro

2024

Psychogeriatrics

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Research criteria for the diagnosis of prodromal dementia with Lewy bodies (DLB) include three clinical subtypes: mild cognitive impairment with Lewy bodies (MCI‐LB), delirium‐onset prodromal DLB, and psychiatric‐onset prodromal DLB. Late‐onset psychiatric manifestations are at a higher risk of developing dementia, but its relation to prodromal DLB remains unclear. In addition to the risk of severe antipsychotic hypersensitivity reactions, accurate discrimination from non‐DLB cases is important due to the potential differences in management and prognosis. This article aims to review a rapidly evolving psychiatric topic and outline clinical pictures of psychiatric‐onset prodromal DLB, including the proposed biomarker findings of MCI‐LB: polysomnography‐confirmed rapid eye movement sleep behaviour disorder, cardiac [123I]metaiodobenzylguanidine scintigraphy, and striatal dopamine transporter imaging. We first reviewed clinical pictures of patients with autopsy‐confirmed DLB. Regarding clinical reports, we focused on the patients who predominantly presented with psychiatric manifestations and subsequently developed DLB. Thereafter, we reviewed clinical studies regarding the diagnostic applications of the proposed biomarkers to patients with late‐onset psychiatric disorders. Clinical presentations were mainly late‐onset depression and psychosis; however, other clinical manifestations were also reported. Psychotropic medications before a DLB diagnosis may cause extrapyramidal signs, and potentially influences the proposed biomarker findings. These risks complicate clinical manifestation interpretation during the management of psychiatric symptoms. Longitudinal follow‐up studies with standardised evaluations until conversion to DLB are needed to investigate the temporal trajectories of core features and proposed biomarker findings. In patients with late‐onset psychiatric disorders, identification of patients with psychiatric‐onset prodromal DLB provides the opportunity to better understanding the distinct prognostic subgroup that is at great risk of incident dementia. Advances in the establishment of direct biomarkers for the detection of pathological α‐synuclein may encourage reorganising the phenotypic variability of prodromal DLB.

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Section: Late-onset Depressionmentioning

confidence: 99%

Clinical presentations and diagnostic application of proposed biomarkers in psychiatric‐onset prodromal dementia with Lewy bodies

Kobayashi,

Iwata‐Endo,

Fujishiro

2024

Psychogeriatrics

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“…In this study, we focused on patients who had a diagnosis of severe depression. Furthermore, previous studies reported that DAT would be useful for not only diagnosis of prodromal DLB [46], but also differential diagnosis between late-life depression and DLB [47,48]. almost all patients in dementia had undergone DAT.…”

Section: Comparisons Of Clinical Characteristics Between Mdd With And...mentioning

confidence: 99%

Prevalence of Comorbid Dementia in Late-life Depression and Bipolar Disorder: A Retrospective Inpatient Study

Ochi

Mori

Iga

et al. 2022

Journal of Alzheimer's Disease Reports

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Background: Dementia in patients with late-life mood disorders is clinically important. Objective: We aimed to investigate the prevalence of dementia in patients with late-life major depressive disorder (MDD) or bipolar disorder (BD) and to clarify the clinical characteristics associated with the diagnosis of dementia. Methods: The prevalence of dementia at hospital discharge and the clinical characteristics at hospitalization who are diagnosed with MDD or BD over 65 years of age, from the medical records of 684 patients who had been admitted from 2015 to 2020 were investigated. Results: A total of 66 patients with MDD (n = 50) and BD (n = 16) were analyzed. The prevalence of dementia was significantly higher in MDD than in BD (24.0% versus 0% ; p = 0.026). The mean age at onset of MDD was significantly older in the MDD with dementia group than in the MDD without (76.9±6.3 years versus 62.2±14.0 years; p < 0.001). The rate of first depressive episode at this admission was significantly higher in the MDD with dementia group (91.7% versus 30.3% ; p < 0.001). The diagnosis of dementia was significantly associated with lower scores for “insomnia early” (p = 0.019) and higher scores for “insight” (p = 0.049) on the 17-item Hamilton Depression Rating (HAMD-17) subscales and lower scores for “recall” (p = 0.003) on the MMSE subscales. Conclusion: The older age of first onset of depression, “insomnia early”, “insight” and “recall” may be useful indicators for a diagnosis of dementia in late-life depression.

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The clinical phenotype of psychiatric-onset prodromal dementia with Lewy bodies: a scoping review

Gunawardana,

Matar,

Lewis

2023

J Neurol

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Background Recent consensus research criteria have identified a ‘psychiatric onset’ form of prodromal dementia with Lewy bodies (DLB) characterised by prominent late-onset psychiatric symptoms. Although recognised as important to raise the index of diagnostic suspicion, evidence regarding this cohort was deemed too limited to impose formal criteria. We reviewed the published literature on psychiatric-onset DLB to identify key clinical characteristics and evidence gaps to progress our understanding of this entity. Methods Medline, PubMed and Embase were searched for relevant articles containing longitudinal follow-up of patients initially presenting with a psychiatric illness who subsequently developed DLB according to the diagnostic criteria available at the time. Results Two cohort studies (18 and 21 patients) along with 12 case series (13 cases) were identified totalling 52 patients (63% female). Initial psychiatric presentation occurred at a mean of 63 years (range 53–88), with depression being the most frequently reported psychiatric presentation (88%). Psychotic presentations were less common on presentation (11%) but became more prevalent throughout the prodromal period before the diagnosis of DLB (83%). Relapses of the psychiatric disease were common occurring in 94% (32/34) of patients. Parkinsonism, cognitive fluctuations, visual hallucinations, and REM sleep behaviour disorder were uncommonly reported at initial presentation (3.8%). Conclusions Psychiatric-onset DLB is characterized by a female predominant relapsing–remitting psychiatric illness presenting with affective symptoms but later developing psychotic features prior to the onset of DLB. Additional prospective studies including other neurodegenerative cohorts with harmonised assessments are required to inform definitive diagnostic criteria for this condition.

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Can we identify prodromal dementia with Lewy bodies in late‐life depression?

Cited by 4 publications

References 10 publications

Clinical presentations and diagnostic application of proposed biomarkers in psychiatric‐onset prodromal dementia with Lewy bodies

Clinical presentations and diagnostic application of proposed biomarkers in psychiatric‐onset prodromal dementia with Lewy bodies

Prevalence of Comorbid Dementia in Late-life Depression and Bipolar Disorder: A Retrospective Inpatient Study

The clinical phenotype of psychiatric-onset prodromal dementia with Lewy bodies: a scoping review

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