Psychotic Features Among Patients in the Prodromal Stage of Dementia with Lewy Bodies During Longitudinal Observation

Abstract

Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusional-hallucinatory, and seven were manic and/or depressive. Seven of the 21 cases exhibited delirium during longitudinal observation. A psychotic state repeatedly appeared without any trigger in 20 of the 21 patients. All subjects developed cognitive impairment at 9.1±4.6 (mean±SD) years after the initial appearance of psychotic symptoms, and subsequently diagnosed with DLB at 71.3±6.1 (mean±SD) years. Conclusion: Elderly patients with psychotic symptoms, such as catatonia, delusion-hallucination, manic and/or depressive features, and delirium without dementia, could indicate symptomatic psychosis or a prodromal stage of any neurocognitive disorder such as DLB. Therefore, further extensive workout (e.g., radioisotope neuroimaging) is required to avoid misdiagnosis.

Temporal trajectories of proposed biomarkers in psychiatric‐onset prodromal dementia with Lewy bodies: a case report

“…The duration until progression to DLB ranged from approximately 5 to 10 years. Utsumi et al 5 investigated the clinical course of psychiatric-onset DLB. Of the 21 patients with a final diagnosis of DLB, 18 exhibited depression as the initial manifestation.…”

“…The duration until progression to DLB ranged from approximately 5 to 10 years. Utsumi et al 5 . investigated the clinical course of psychiatric‐onset DLB.…”

Delirium-Onset of Prodromal Dementia With Lewy Bodies—Putative Brainstem-Related Pathomechanism and Clinical Relevance

“…However, no large scale studies exist on this topic. Not a delirium-onset, but delirium was nevertheless observed in 7/21 (33%) of DLB patients during the observation period (Utsumi et al, 2021). Nearly all their patients presented psychotic symptoms as a precursor of DLB (20/21, 95%) as the authors focused on a psychiatric onset of prodromal DLB.…”

Electroconvulsive therapy as a potential therapeutic option in psychiatric‐onset prodromal dementia with Lewy bodies

“…Takahashi et al reported that hypersensitivity to psychotropics was observed in 72.8% of 18 patients with late-onset major depressive disorder who progressed to DLB. 8 These findings suggest that drug therapy-resistant psychotic conditions might not be uncommon in the prodromal DLB state. In line with the findings of a recent review regarding ECT for Parkinson's disease, ECT improved motor symptoms as well as psychiatric symptoms in our patient.…”