Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease, and vascular dementia

Walker, Matthew P.; Ayre, G.; Cummings, Jeffrey L.; Wesnes, Keith; McKeith, Ian; O’Brien, John T.; Ballard, Clive

doi:10.1212/wnl.54.8.1616

Cited by 250 publications

(191 citation statements)

References 36 publications

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“…The questionnaires are able to discriminate 85% of DLB patients, as confirmed by autopsy [7]. Cognitive fluctuations are considered a clinical feature typical of DLB, described in 70-80% of these patients, only in 14-20% of AD patients and in 15-30% of VaD subjects [8].…”

Section: Synucleinopathies: Dementia With Lewy Bodiesmentioning

confidence: 87%

“…Only in 3 of the DLB patients presenting with R2 delays, discrepant latencies on the two sides of stimulation were found [8], yet ipsilateral and contralateral responses were always overlapping, thus it is likely that the afferent pathway is prominently involved in DLB. In a successive study we tested the supposition that BR alterations present in DLB patients are sensitive to cholinergic modulation.…”

Section: Blink Reflex Abnormalitiesmentioning

confidence: 94%

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Is There a Place for Clinical Neurophysiology Assessments in Synucleinopathies?

Onofrj¹,

Bonanni²,

Thomas³

et al. 2011

Neuroimaging for Clinicians - Combining Research and Practice

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IntroductionParkinson Disease (PD), Dementia with Lewy Bodies (DLB) and Multiple System Atrophy (MSA) are characterized by deposition of Lewy Bodies (LB), consisting of eosinophilic intracellular (intraneural in PD and DLB and intraglial in MSA) inclusions of -synuclein and allowing the three disorders to be categorized as synucleinopathies. The identification in the last two decades of specific clinical features of synucleinopathies has been a major breakthrough in Neurology, as it prompted a reconsideration of diagnostic and therapeutic approaches to dementia and parkinsonism. The recognition of synuclein and ubiquitin markers in dementia resulted in the reclassification of patients previously considered as affected by Alzheimer Disease (AD) and Vascular Dementia (VaD), and there is now agreement that DLB is the second most common cause of dementia in elderly population: its prevalence is reported to be in the 25-43% range in different studies. DLB is clinically characterized by the presence of prominently dysexecutive dementia (frontal lobe or subcortical dementia according to earlier classification [1]), cognitive fluctuations, consisting of remitting-relapsing episodes of blunted conscience reaching levels of stupor, by the occurrence of visual hallucinations and delusions, by parkinsonian motor signs and hypersensitivity to neuroleptic treatment, ranging from worsening of parkinsonism to the possible lethal neuroleptic-malignant syndromes [2]. Yet, variances of presentation and overlapping symptoms with AD and Fronto-Temporal lobe Degeneration (FTD), could be misleading in the process of addressing a clinical diagnosis with consequent therapeutic risks(e.g. introducing neuroleptic treatments in patient with DLB), or economic costs (e.g. addressing patients with DLB to treatment protocols dedicated to AD patients, based on vaccines or antibodies against amyloid proteins, a neuropathological feature of AD). It is evident the stringent need for improvement of reliable diagnostic tools (u.e. biomarkers) to differentiate the diseases associated with dementia. In 2010 the National Institute of Health, NIH, held a symposium focused on the development of possible biomarkers for DLB. Among the different suggested biomarkers, neurophysiological assessments were reconsidered, as a large amount of neurophysiological studies had been devoted to AD and PD, whose characteristics are shared by DLB. www.intechopen.com Neuroimaging for Clinicians -Combining Research and Practice 300We contributed to several studies on this argument along the years, and in the present chapter we discuss the role of clinical neurophysiological studies in DLB in comparison with other disorders. The essential background of our original studies laid in the fact that most historical studies were performed when the DLB clinical entity was unknown and therefore some of the past results were marred by absent recognition of this clinical entity. Synucleinopathies: Dementia with lewy bodiesSynucleinopathies comprise a diverse groups of neurodegenerati...

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Section: Synucleinopathies: Dementia With Lewy Bodiesmentioning

confidence: 87%

Section: Blink Reflex Abnormalitiesmentioning

confidence: 94%

Is There a Place for Clinical Neurophysiology Assessments in Synucleinopathies?

Onofrj¹,

Bonanni²,

Thomas³

et al. 2011

Neuroimaging for Clinicians - Combining Research and Practice

View full text Add to dashboard Cite

show abstract

“…The working group concluded that existing testing procedures (e.g., the Alzheimer's disease assessment scale) do not properly identify all cognitive deficits characterizing AD patients, in particular attention deficits, and has recommended that automated procedures be used alongside more traditional ones to ultimately determine whether they should supersede traditional methods [9]. The CDR system has shown sensitivity in identifying mild cognitive impairment [27,41] and is able to differentiate various types of dementia (AD, DLB, VD, Huntington's Chorea [25,[35][36][37][38]). The CDR system measures therapeutic response to a variety of medications in both AD [2,7,24,32,34] and DLB [22] and shows superior sensitivity in identifying AD and Huntington's disease as compared to all the most widely used non-automated procedures [25].…”

Section: The Cdr Systemmentioning

confidence: 99%

“…DLB has previously been mistakenly diagnosed as Alzheimer's disease and sometimes has been confused with schizophrenia. One of the major problems in the performance of clinical trials with DLB is the correct diagnosis of the disorder [23,[36][37][38].…”

Section: Introductionmentioning

confidence: 99%

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Reliable diagnoses of dementia by the naive credal classifier inferred from incomplete cognitive data

Zaffalon

Wesnes²,

Petrini³

2003

Artificial Intelligence in Medicine

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Dementia is a serious personal, medical and social problem. Recent research indicates early and accurate diagnoses as the key to effectively cope with it. No definitive cure is available but in some cases when the impairment is still mild the disease can be contained. This paper describes a diagnostic tool that jointly uses the naive credal classifier and the most widely used computerized system of cognitive tests in dementia research, the Cognitive Drug Research system. The naive credal classifier extends the discrete naive Bayes classifier to imprecise probabilities. The naive credal classifier models both prior ignorance and ignorance about the likelihood by sets of probability distributions. This is a new way to deal with small or incomplete data sets that departs significantly from most established classification methods. In the empirical study presented here the naive credal classifier provides reliability and unmatched predictive performance. It delivers up to 95% correct predictions while being very robust with respect to the partial ignorance due to the largely incomplete data. The diagnostic tool also proves to be very effective in discriminating between Alzheimer's disease and Dementia with Lewy Bodies.

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Attention and Fluctuating Attention in Patients With Dementia With Lewy Bodies and Alzheimer Disease

et al. 2001

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This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction time appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits.

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Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease, and vascular dementia

Abstract: Standardized assessment methods demonstrate that FC is significantly more common and severe in DLB than in other major dementias. The periodicity of FC is different in DLB and VaD cases, with important implications for the underlying causal mechanisms and for differential diagnosis.

Cited by 250 publications

References 36 publications

Is There a Place for Clinical Neurophysiology Assessments in Synucleinopathies?

Is There a Place for Clinical Neurophysiology Assessments in Synucleinopathies?

Reliable diagnoses of dementia by the naive credal classifier inferred from incomplete cognitive data

Attention and Fluctuating Attention in Patients With Dementia With Lewy Bodies and Alzheimer Disease

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