Personality traits distinguishing dementia with Lewy bodies from Alzheimer disease

Abstract

Objective: To identify personality traits that distinguish dementia with Lewy bodies (DLB) from Alzheimer disease (AD). Methods: We examined 290 participants enrolled in a longitudinal study (nondemented control ϭ 34, DLB ϭ 128, AD ϭ 128) followed to autopsy. As part of the annual interview with the collateral source, the clinician asked about specific changes in personality, interests, and drives based on items from the Blessed Dementia Scale (BDS). Statistical analysis was performed using 2 and Fisher exact tests. Factor analysis was performed to determine underlying structure and receiver operating characteristic curves assessed the ability for each of three derived factors to discriminate DLB from AD. Results: The sample was evaluated for a mean of 4.8 visits (range 1 to 14) with a mean age of 77.6 Ϯ 9.9 years. The participants' cognitive status ranged from nondemented (Clinical Dementia Rating [CDR] 0) through all stages of dementia (CDR Ն 0.5). Personality traits that distinguished DLB included diminished emotional responsiveness (p ϭ 0.004), relinquishing hobbies (p ϭ 0.01), growing apathy (p ϭ 0.03), and purposeless hyperactivity (p ϭ 0.003).Factor analyses of the BDS revealed a PASSIVE factor (diminished emotional responsiveness, relinquished hobbies, growing apathy, and purposeless hyperactivity) explaining 10.4% of variance and that DLB was more likely to manifest these personality traits than AD (p ϭ 0.001). The PASSIVE factor discriminated DLB from AD (area under the curve ϭ 0.61, 95% CI: 0.54 to 0.68, p ϭ 0.006).Any change in personality is associated with the presence of visual hallucinations. Conclusions: Our results suggest that incorporating a brief, simple inventory of personality traits may improve the identification of individuals with dementia with Lewy bodies. NEUROLOGY 2007;68: [1895][1896][1897][1898][1899][1900][1901] Identifying the earliest features of dementia enables clinicians to implement therapy as soon as possible and provides patients and families more time to plan for the accompanying progressive decline. Much effort has focused on the cognitive symptoms of dementia syndromes such as impairments in memory, visuospatial, attention, and executive function. An alternative approach to improve early detection is to study noncognitive symptoms such as behavioral and personality changes that may precede diagnosis or occur early in the course of the dementia.

Neuropsychiatric Symptoms in Amnestic and Nonamnestic Mild Cognitive Impairment

“…In particular, the different personality traits [37] , the presence of hallucinations, sleep disturbances and extrapyramidal signs, included in the core features of LBD [38,39] , would suggest that Lewy body pathology might be a contributing factor to the clinical profile of naMCI.…”

Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

“…Alzheimer patients who develop apathy reportedly decline faster cognitively than those who do not manifest apathy (Lechowski et al 2009). In other dementias (including frontotemporal, Lewy body and vascular) as well as in mild cognitive impairment (MCI), the reported prevalence of apathy ranges from 38 to 95% (Robert et al 2006;Galvin et al 2007). In frontotemporal dementia, apathy is the most common presenting symptom and with disease progression apathy appears in 62-89% of patients (Mendez et al 2008).…”

Interpersonal traits change as a function of disease type and severity in degenerative brain diseases

“…Depending on the neuroanatomical localisation of brain damage, personality changes differ in degree and direction, allowing differentiation among various degenerative brain diseases2 3 and between degenerative and non-degenerative brain diseases 4 5. Recently, disease-specific personality changes have been associated with degenerative lesions to specific brain structures 6…”