Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Zahirovic, Iris; Wattmo, Carina; Torisson, Gustav; Minthon, Lennart; Londos, Elisabet

doi:10.1016/j.jamda.2016.03.017

Cited by 25 publications

(21 citation statements)

References 32 publications

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“…Our result might be due to the high mean age of our population (80.1 years). To explain their results, Zahirovic et al [ 32 ] relied on previous studies that had shown higher prevalence of DLB in men in the age group 70–79 years and more balanced prevalence in age groups older than 80 years. Indeed, we observed in our study that, contrary to younger people, for those older than 75 years, DLB is more common in females, and the sex ratio in favor of females increases with age.…”

Section: Discussionmentioning

confidence: 99%

Sex ratio in dementia with Lewy bodies balanced between Alzheimer’s disease and Parkinson’s disease dementia: a cross-sectional study

et al. 2018

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BackgroundGender distribution varies across neurodegenerative disorders, with, traditionally, a higher female frequency reported in Alzheimer’s disease (AD) and a higher male frequency in Parkinson’s disease (PD). Conflicting results on gender distribution are reported concerning dementia with Lewy bodies (DLB), usually considered as an intermediate disease between AD and PD. The aim of the present study was to investigate gender differences in DLB in French specialized memory settings using data from the French national database spanning from 2010 to 2015 and to compare sex ratio in DLB with that in AD, Parkinson’s disease dementia (PDD), and PD. Our hypothesis was that there is a balanced sex ratio in DLB, different from that found in AD and PD.MethodsWe conducted a repeated cross-sectional study. The study population comprised individuals with a DLB, AD, PDD, or PD diagnosis according to the International Classification of Diseases, Tenth Revision, in the French National Alzheimer Database between 2010 and 2015. Sex ratio and demographic data were compared using multinomial logistic regression and a Bayesian statistical model.ResultsFrom 2010 to 2015 in French specialized memory settings, sex ratios (female percent/male percent) were found as follows: 1.21 (54.7%/45.3%) for DLB (n = 10,309), 2.34 (70.1%/29.9%) for AD (n = 135,664), 0.76 (43.1%/56.9%) for PD (n = 8744), and 0.83 (45.4%/54.6%) for PDD (n = 3198). Significant differences were found between each group, but not between PDD and PD, which had a similar sex ratio.ConclusionsThis large-sample prevalence study confirms the balanced gender distribution in the DLB population compared with AD and PD-PDD. Gender distribution and general demographic characteristics differed between DLB and PDD. This is consistent with the hypothesis that DLB is a distinct disease with characteristics intermediate between AD and PD, as well as with the hypothesis that DLB could have at least partially distinct neuropathological correlates.

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Section: Discussionmentioning

confidence: 99%

Sex ratio in dementia with Lewy bodies balanced between Alzheimer’s disease and Parkinson’s disease dementia: a cross-sectional study

et al. 2018

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“…The nursing staff were instructed to register the presence/absence of seven actual clinical features at the time of scoring: 1) Parkinson’s disease (PD) or parkinsonism; 2) rigidity, signs of stiffness; 3) tremor and/or a rigid posture and walk; 4) a weak voice; 4) balance problems, dizziness, faints, falling easily and/or more frequently; 5) visual hallucinations; 6) excessive daytime sleepiness, variations in attention and wakefulness; and 7) sleep disorder, acting out dreams during sleep (sometimes violently), shouting out at night, nightmares. A more detailed description of the questionnaires is presented in an earlier publication [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study of the same population, we reported an underdiagnosed prevalence of clinical DLB features in NHs [ 29 ]. The aim of the present study was to investigate the usage of psychotropic medication (antipsychotics, hypnotics/sedatives, anti-depressants, anxiolytics and anti-dementia medication) in Swedish NHs with a special focus on patients with clinical features of DLB.…”

Section: Introductionmentioning

confidence: 99%

Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden

et al. 2018

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BackgroundElderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden.MethodsBetween 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women.ResultsTreatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62–69%).ConclusionsResidents with 2–4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.

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“…49 The prevalence of older adults with 2 or more DLB symptoms in nursing homes ranges from 16% to 20%. 50 Furthermore, patients with DLB also appear to be more acutely sensitive to minor insults (even subclinical events) and, thus, more delirium “prone.” Consequently, and unsurprisingly, delirium is more commonly diagnosed in DLB than AD 51 with 32% of outpatients with DLB experiencing delirium as opposed to 15% of outpatients with AD. 52 …”

Section: Dementia With Lewy Bodies and The Influence On Tests Used Tomentioning

confidence: 99%

The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

Morandi

Davis

Bellelli

et al. 2017

Journal of the American Medical Directors Association

163

116

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Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies.

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Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Abstract: We conclude that elderly with 2 or more DLB symptoms may constitute between 16% and 20% of all residents in NHs. This emphasizes the importance of identification of DLB and guides clinicians to deliver appropriate treatment for this fragile patient group.

Cited by 25 publications

References 32 publications

Sex ratio in dementia with Lewy bodies balanced between Alzheimer’s disease and Parkinson’s disease dementia: a cross-sectional study

Sex ratio in dementia with Lewy bodies balanced between Alzheimer’s disease and Parkinson’s disease dementia: a cross-sectional study

Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden

The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

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