Motor and cognitive function in Lewy body dementia: comparison with Alzheimer's and Parkinson's diseases.

Gnanalingham, KannaK.; Byrne, E. Jane; Thornton, Andrew; Sambrook, M.A.; Bannister, P.

doi:10.1136/jnnp.62.3.243

Cited by 208 publications

(155 citation statements)

References 39 publications

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Section: Abstract-objectivesupporting

confidence: 62%

“…Some studies report PDD to be more impaired, 6,7 whereas other studies found no differences. 8,9 Similar inconsistencies have been found when perception of PD patients was compared with healthy controls.10 Since operationalized criteria to define the clinical boundaries between PD and PDD or PDD and DLB require refinement, these inconsistencies may be partly due to diagnostic heterogeneity. When DLB was compared with AD, studies consistently reported greater visual impairment in DLB 11 and a recent study found similar impairments in pentagon copying in DLB and PDD.…”

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confidence: 86%

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Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Mosimann

Mather²,

Wesnes³

et al. 2004

Neurology

260

176

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Abstract-Objective:To quantify visual discrimination, space-motion, and object-form perception in patients with Parkinson disease dementia (PDD), dementia with Lewy bodies (DLB), and Alzheimer disease (AD). Methods: The authors used a cross-sectional study to compare three demented groups matched for overall dementia severity (PDD: n ϭ 24; DLB: n ϭ 20; AD: n ϭ 23) and two age-, sex-, and education-matched control groups (PD: n ϭ 24, normal controls [NC]: n ϭ 25). Results: Visual perception was globally more impaired in PDD than in nondemented controls (NC, PD), but was not different from DLB. Compared to AD, PDD patients tended to perform worse in all perceptual scores. Visual perception of patients with PDD/DLB and visual hallucinations was significantly worse than in patients without hallucinations. Conclusions: Parkinson disease dementia (PDD) is associated with profound visuoperceptual impairments similar to dementia with Lewy bodies (DLB) but different from Alzheimer disease. These findings are consistent with previous neuroimaging studies reporting hypoactivity in cortical areas involved in visual processing in PDD and DLB. NEUROLOGY 2004;63:2091-2096 Parkinson disease (PD) is associated with a higher risk of developing dementia compared to healthy elderly controls; longitudinal studies suggest that up to 78% of PD patients will develop dementia after nearly two decades of motor symptoms.1 Once dementia is established, clinical symptoms of PD dementia (PDD) may show, apart from a longer duration of motor features, considerable overlap with dementia with Lewy bodies (DLB). The postural instability-gait type of parkinsonism is overrepresented in PDD and DLB 2 and both disorders show similar fluctuation of attention 3 and response to cholinergic therapy. 4,5 Studies comparing visual perception and visual construction of PDD with Alzheimer disease (AD) have revealed contradictory results. Some studies report PDD to be more impaired, 6,7 whereas other studies found no differences. 8,9 Similar inconsistencies have been found when perception of PD patients was compared with healthy controls.10 Since operationalized criteria to define the clinical boundaries between PD and PDD or PDD and DLB require refinement, these inconsistencies may be partly due to diagnostic heterogeneity. When DLB was compared with AD, studies consistently reported greater visual impairment in DLB 11 and a recent study found similar impairments in pentagon copying in DLB and PDD.12 Some of these studies used construction tasks as evidence, but this may not be legitimate given the motor impairments in these patients. Studies quantifying visual perception of DLB and PDD using tasks without motor requirements are lacking.Peripheral structures such as the retina, the optic nerve and tract, and primary visual cortex are multimodal in their function, whereas the visual association cortex is more specialized.13 Low-level visual discrimination is mainly processed in visual area V1/ V2, whereas high-level visual functions require additional activati...

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Section: Abstract-objectivesupporting

confidence: 62%

mentioning

confidence: 86%

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Mosimann

Mather²,

Wesnes³

et al. 2004

Neurology

260

176

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“…Similarly, executive dysfunction as measured by tasks such as Trails A and B and card sorting are prominent in DLB. 35,36 These features on testing are consistent with the early clinical symptoms reported in fluctuations in alertness. However, orientation has been observed to be relatively preserved in DLB with respect to AD, as memory loss, particularly episodic and recognition memory, may be less severe early on in DLB than AD and PDD.…”

Section: Clinical Coursesupporting

confidence: 71%

“…By contrast, AD patients tend to improve between the drawing and copying portion of the clock task. 35,36 Other areas of cognitive deficit that are more pronounced in DLB than in AD include verbal fluency, psychomotor speed, and executive function. 35 The verbal dysfluency has been found to be more severe in DLB than in AD patients, specifically in letter fluency, whereas in AD letter fluency is relatively intact when compared with category fluency.…”

Section: Clinical Coursementioning

confidence: 99%

Dementia with Lewy Bodies

Mayo

Bordelon

2014

Semin Neurol

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).Dementia with Lewy bodies (DLB) is an atypical parkinsonian disorder characterized as a synucleinopathy based on the cardinal pathologic finding, the Lewy body, a neuronal inclusion comprised of aggregated α-synuclein. Lewy bodies are found in brainstem nuclei in both Parkinson disease (PD) as well as in DLB, though in DLB there is a concomitant presence of Lewy bodies in the cortex and subcortical white matter. The cortical Lewy bodies may not demonstrate the classic structure of an eosinophilic core with surrounding halo; however, they contain α-synuclein. Clinically, DLB manifests with fluctuating alertness, visual hallucinations, and parkinsonian motor symptoms, and has features of both a cortical and a subcortical dementia. EpidemiologyDementia with Lewy bodies is the second most common pathologic diagnosis of dementia, next to Alzheimer disease (AD) and accounts for 25% of all dementias. 1 The prevalence of DLB is estimated to be 0.7% of the population over 65 years of age. 2 Given the challenge of clinical diagnostic accuracy in dementia, there is a wide variation in estimates of the prevalence among dementia patients, ranging from 3 to 26.3% in those over the age of 65 years. 3,4 The incidence of DLB is 3.5 per 100,000 person years and this increases with age. 5 There is a slightly greater male predominance of 1.9:1. 6 Risk factors of DLB include advanced age, hypertension, hyperlipidemia, and carriers of one or more APOE ε4 alleles. 7-9 As in PD, there is overrepresentation of the CYP2D6B allele, and a greater heterozygous frequency of glucocerebrosidase 1 (GBA1) estimated at 3.5% versus 2.9% in Parkinson disease dementia (PDD) and 0.4% in the general population. 10 A separate study also found a significant association between GBA1 mutation carrier status and DLB with an odds ratio of 8.28 versus 6.48 in PDD. 11 PathophysiologyDementia with Lewy bodies is considered a synucleinopathy, along with PD and multiple system atrophy (MSA). It is distinguished pathologically by the presence of Lewy bodies, which are intracellular inclusions with an eosinophilic core Keywords ► dementia with Lewy bodies ► Lewy body ► synucleinopathy ► dementia ► parkinsonism AbstractDementia with Lewy bodies (DLB) is the second most common diagnosis of dementia after Alzheimer disease (AD). The essential pathologic feature is the Lewy body, a neuronal inclusion containing α-synuclein, found in brainstem nuclei and the neocortex. Clinical features include early fluctuations in attention, hallucinations, and parkinsonism, with progression to a combined cortical and subcortical dementia. To distinguish it from Parkinson disease dementia, a time course of one year from cognitive changes to motor feature onset has been established. There is more severe impairment of verbal fluency, executive function, and visuospatial abilities in DLB patients. Both rapid eye movement sleep behavior disorder and neuroleptic sensitivity are notable in this patient group. Treatment is aimed at symptom management. Cholinesterase inhibitors can be bene...

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“…A recent metaanalytic study by Collerton et al (2003) systematically reviewed 21 studies comparing the cognitive performance of DLB patients; they found that the effect size (Cohen's d: averaged across multiple cognitive domains) was, in fact, larger for DLB (2.0-2.2) than AD (1.4-1.6) patients. Studies comparing AD and DLB patients have pinpointed some differences in cognitive performance: memory impairment is less severe in DLB than AD (e.g., Calderon et al, 2001;Salmon et al, 1996;Shimomura et al, 1998), while visual-perceptual and spatial abilities are more impaired (e.g., Ala et al, 2001;Calderon et al, 2001;Gnanalingham et al, 1997;Salmon et al, 1996). Consistent with the neuropsychological profile, functional imaging studies show that patients with DLB more commonly have reduced perfusion in the occipital lobes than AD patients (Ishii et al, 1999;Lobotesis et al, 2001).…”

Section: Introductionmentioning

confidence: 51%

A predominance of category deficits for living things in Alzheimer's disease and Lewy body dementia

Laws

Crawford

Gnoato

et al. 2007

J. Inter. Neuropsych. Soc.

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Although semantic memory impairment is well documented in patients with dementia of the Alzheimer's type, questions remain as to whether the deficit extends to other forms of dementia and whether it differentially affects different domains of knowledge. We examined category naming on two tasks (picture naming and naming-to-description) in patients with Alzheimer's disease (AD: n 5 11), Lewy body dementia (DLB: n 5 11) and healthy elderly matched controls (n 5 22). The DLB and AD groups showed significantly worse naming on both tasks, although the AD patients were more impaired than the DLB patients. Like some AD patients, some DLB patients showed evidence of category-specific naming deficits, and strikingly, all 25 significant category dissociations were for living things. The latter finding accords with the preponderance of living deficits previously documented for AD patients, but extends this finding to DLB patients. The implications of this category bias is discussed in relation to relevant models of category specificity. (JINS, 2007, 13, 401-409.)

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Motor and cognitive function in Lewy body dementia: comparison with Alzheimer's and Parkinson's diseases.

Abstract: Objective-Motor and cognitive function were compared in

Cited by 208 publications

References 39 publications

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Dementia with Lewy Bodies

A predominance of category deficits for living things in Alzheimer's disease and Lewy body dementia

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