Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences

Abstract

Aim: Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there are almost no reports of the initial symptoms of DLB assessed in a large number of cases. We retrospectively evaluated the initial symptoms of 234 participants with DLB and DLB-related symptoms at diagnosis and characterized any gender differences in the symptom profiles. Methods: This study consisted of 234 participants with probable DLB who met the diagnostic criteria outlined in the Fourth Consensus Report of the DLB Consortium (2017). DLB was confirmed based on several characteristic biomarkers for dopamine transporter imaging with 123 IN -omegafluoropropyl-2-beta-carbomethoxy-3-beta (4-iodophenyl) nortropane singlephoton emission computed tomography, 123 I-metaiodobenzylguanidine myocardial scintigraphy, and brain perfusion measured with single photon emission computed tomography. In addition, core and supportive clinical features were considered in the diagnosis. Results: Initial symptoms included cognitive impairment (41.9%) and psychiatric symptoms (i.e. visual and auditory hallucinations, delusions, and depression) (42.3%). Almost half of the women initially presented with psychiatric symptoms, with significantly more women than men presenting with auditory hallucinations. In contrast, men had a significantly higher rate of rapid eye movement sleep behaviour disorder (RBD) than women did. At diagnosis, DLB-related symptoms differed between men and women, with male patients exhibiting significantly more RBD, parkinsonism, hyposmia, and syncope than female patients. Moreover women presented significantly more often with auditory hallucinations than did men. Conclusions: Our results indicate that there are gender differences in the initial symptoms of DLB, as well as in the presentation of subsequent symptoms observed at diagnosis. There was a higher incidence of RBD in men, whereas women had a higher incidence of psychotic symptoms.

Locus Coeruleus Malfunction Is Linked to Psychopathology in Prodromal Dementia With Lewy Bodies

“…Diverse studies provided evidence that psychiatric symptoms such as acoustic hallucinations, delusions, and depressive symptoms at disease onset are much more often present in DLB than in AD patients in clinically diagnosed DLB and autopsy-confirmed DLB patients (Ballard et al, 1999). Furthermore, a psychiatric onset of DLB was discerned in nearly half of 234 DLB patients (Utsumi et al, 2020), thus supporting psychiatric prodromal DLB as a main clinical entity of prodromal DLB.…”

Clinical characteristics of Lewy body dementia in Chinese memory clinics

“…Gender differences have also been reported in the initial symptoms of DLB. Utsumi et al [37] suggested considering DLB in elderly aged men who report RBD, because males tend to present with more RBD symptom than females. Therefore, the gender distribution of LBD may have a greater disparity, with males at a higher risk.…”

Gender differences in initial symptoms and symptoms at diagnosis in dementia with Lewy bodies

“…There are gender differences in the initial symptoms of dementia with Lewy bodies (DLB) and the symptoms when the diagnosis is confirmed, with females having been found to frequently exhibit more psychotic symptoms such as visual/auditory hallucinations, delusions, and depression compared to males. 1 Meanwhile, the frequency of rapid eye movement sleep behaviour disorder is significantly higher in males. Fujishiro et al 2 sent a letter to us, offering an overview of the possibility that gender differences in incidence of DLB may affect these results, and they included a review of the literature, such as clinical and pathology reports, highlighting that consensus has not been reached regarding the gender differences in DLB incidence.…”