Different Clinical and Neuroimaging Characteristics in Early Stage Parkinson’s Disease with Dementia and Dementia with Lewy Bodies

Abstract

Parkinson’s disease with dementia (PDD) and dementia with Lewy bodies (DLB) both commonly exhibit brain Lewy body pathology and similar end-stage symptoms, but early symptoms differ. To clarify these differences, we compared the demographic characteristics, symptoms, cognitive and affective functioning, activities of daily life, and neuroimaging results between PDD (n = 52) and DLB (n = 46) patients. In measures of cognitive functioning, PDD patients had worse Hasegawa dementia scale-revised (HDS-R) scores (11.2±4.8) and better frontal assessment battery (FAB) scores (11.3±4.1) compared with DLB (17.0±6.4, p = 0.013 and 8.6±4.7, p = 0.039, respectively). DLB patients performed worse than PDD patients in “orientation to place” tasks. In affective functions, DLB patients had worse GDS (7.6±3.4) and ABS (9.9±5.3) scores than PDD patients (5.1±4.1 and 4.8±3.0, respectively). 99mTc-ECD images showed greater CBF in the whole cingulate gyrus and a lower CBF in the precuneus area in DLB than in PDD. These results suggest that PDD patients’ lower average scores for “repetition” (MMSE), “recent memory” (HDS-R), and “lexical fluency” (FAB) were related to lower CBF in the cingulate gyrus than in DLB. Furthermore, DLB patients’ poorer average subscale scores of “orientation to place” (MMSE) and “similarities”, “conflicting instructions”, and “go-no go” (FAB) tasks may be related to the lower CBF in the precuneus area in DLB than PDD.

A descriptive study of Lewy body dementia with functional imaging support in a Chinese population: a preliminary study

“…4 The rate of postural hypotension in both case series is much lower than that reported in other literature on DLB patients, ie 50%. 22 The lower rates of postural hypotension may be related to under-recognition. Similar to our findings, in a study of 22 Chinese DLB patients (mean age, 74 ± 8 years; mean MMSE score, 16 ± 7; mean NPI score, 24 ± 16), three most commonly observed BPSDs were visual hallucinations (86%), delusions (64%), and anxiety (59%); total NPI score was an independent predictor of caregiver burden (odds ratio=1.537; P=0.048).…”

“…Similar to our findings, in a study of 22 Chinese DLB patients (mean age, 74 ± 8 years; mean MMSE score, 16 ± 7; mean NPI score, 24 ± 16), three most commonly observed BPSDs were visual hallucinations (86%), delusions (64%), and anxiety (59%); total NPI score was an independent predictor of caregiver burden (odds ratio=1.537; P=0.048). 22 Clinicians should pay particular attention to BPSD, particularly visual hallucinations and anxiety symptoms, when managing Chinese LBD patients.…”

Review: Clinical, neuropathological and genetic features of Lewy body dementias

“…DLB patients can develop parkinsonism of increasing severity over the years with prevalence between 60 and 92% , although 18% of neuropathologically confirmed DLB cases never developed . Rest tremor is less frequent in DLB than PDD and in DLB is usually milder and more symmetrical . More severe parkinsonism is associated with PDD ; the PIGD phenotype is more likely to be found in PDD (88%) and DLB (69%) compared to PD (38%) .…”

“…Visual recognition memory, semantic fluency and ideomotor praxis are more severely impaired in DLB patients , who also show significantly lower scores on the tests of attention, executive function and constructional tasks . Episodic verbal memory is also worse in DLB than PDD, and the rate of cognitive decline is faster in DLB than PDD and AD . One study showed that the average annual decline in MMSE score in DLB is approximately two points in comparison with PDD (1.8) and AD (1.6) .…”

A Lewy-testes demencia klinikai és neuropatológiai jellemzői

“…Ezek alapján úgy tűnik, hogy DLB esetében gyorsabb progresszió mutatkozik a kognitív tünetek szempontjából a PDD-hez képest [49], a kognitív diszfunkciók profiljá-ban pedig szintén eltérés tapasztalható, már korai fázis-ban, amennyiben a DLB-ben kifejezett a vizuospaciális orientáció zavara, ami mellett a végrehajtó funkciók zavara is súlyosabb károsodást mutat a PDD-hez és ADhez képest is [37]. A memóriakárosodást DLB-ben az AD-hez képest kisebb fokúnak, a PDD-hez képest súlyo-sabbnak mutatták ki a vizsgálatok a betegség korai szakaszában [50]. A pszichiátriai tünetek tekintetében mind a PDD-hez, mind az AD-hez képest gyakoribbak és súlyo-sabbak az affektív tünetek és a pszichotikus tünetek (kü-lönösen a vizuális és extracampin hallucinációk, tévesz-mék) [37].…”