Core and Suggestive Symptoms of Dementia with Lewy Bodies Cluster in Persons with Mild Dementia

Abstract

Objectives: To explore how the core and suggestive symptoms of dementia with Lewy bodies (DLB) cluster in persons with newly diagnosed mild dementia, and whether they are associated with a particular pattern of cognitive impairment. Method: Persons with mild dementia (n = 139) were recruited from dementia clinics in western Norway. Symptoms were rated using standardized instruments. A 2-step cluster analysis was applied to classify persons into groups according to scores on scales for hallucinations, parkinsonism, fluctuations and REM sleep behaviour disorder (RBD). Result: Four distinct clusters were revealed: a ‘Lewy body dementia’ (LBD) cluster with high scores for hallucinations, parkinsonism and fluctuation, and a ‘non-LBD’ cluster with low scores on all DLB symptom scales. In addition, 2 clusters with high scores on either RBD or cognitive fluctuation scales emerged. Persons in the LBD cluster had lower scores for visuospatial cognitive abilities as compared to the non-LBD group (p = 0.002). Conclusion: Applying cluster analysis, we identified distinct subgroups in mild dementia based on symptoms such as hallucinations, parkinsonism and cognitive fluctuations. Our findings provide empirical support for diagnosing DLB. Visual hallucinations and motor parkinsonism might be the most distinguishing symptoms for DLB in mild dementia.

Prevalence of Mild Cognitive Impairment and Its Subtypes in the Heinz Nixdorf Recall Study Cohort

“…A vascular lesion pattern therefore might cause a greater cognitive disturbance in the participants and their relatives and thus be more often reported [47] . Looking at the two other likely outcomes of non-amnestic MCI subtypes, it is known that patients with DLB normally do not suffer from anosognosia and more frequently have symptoms in several neuropsychiatric domains [48,49] . Thus, they might show greater insight than participants with prodromal AD.…”

Early and Presenting Symptoms of Dementia with Lewy Bodies

“…Standardized clinical rating scales were applied to identify the core and suggestive DLB features based on cutoff values for significant symptom severity as recommended in the original papers (see below) or based on a previous study from our group [21]. Visual hallucinations and other psychiatric symptoms were assessed using the Neuropsychiatric Inventory (NPI) [22], a structured, carer-based clinical interview covering 12 psychiatric symptoms commonly occurring in people with dementia, including hallucinations.…”

“…RBD was rated as present if the bed partner reported dream enactment behavior on 3 or more occasions (score of 1). Parkinsonism was rated using the motor subscale of the Unified Parkinson’s Disease Rating Scale [26], and parkinsonism was rated as present with a UPDRS motor subscale score of 10 or more [21]. …”

Neuropsychiatric Symptoms in Mild Dementia with Lewy Bodies and Alzheimer’s Disease

“…In addition to hallucinations, which are part of the diagnostic criteria, apathy, depression, sleep disorders, anxiety, delusions, psychomotor agitation, anhedonia and loss of energy have also been reported [1,2,[9][10][11][12].…”