A comparison of episodic memory deficits in 
neuropathologically-confirmed Dementia with Lewy bodies and 
Alzheimer's disease

Hamilton, Joanne M.; Salmon, David P.; Galasko, Douglas; Delis, Dean C.; Hansen, Lawrence A.; Masliah, Eliezer; Thomas, Ronald G.; Thal, Leon J.

doi:10.1017/s1355617704105043

Cited by 85 publications

(76 citation statements)

References 48 publications

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“…These findings are consistent with other preliminary reports in the literature. 47 Pure DLB participants performed significantly better on all tests of verbal memory than did pure AD or mixed DLB/AD participants. Further, the DLB/AD performance was roughly equivalent to the AD participants on the verbal composite score and its subtests, indicating that LB and AD neuropathologic burden did not produce worse verbal memory in the combined group.…”

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confidence: 78%

Verbal and visuospatial deficits in dementia with Lewy bodies

2005

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Abstract-Objective:To investigate the cognitive decline in dementia with Lewy bodies (DLBs) and characterize the contribution of Lewy bodies (LBs) to cognitive impairment in the presence of concurrent Alzheimer disease (AD). Methods: Cognitive deficits and rates of progression attributable to DLB and AD neuropathology were investigated in three groups of participants from the longitudinal cohort of the Alzheimer Disease Research Center at Washington University with autopsy-confirmed diagnoses of pure DLB (n ϭ 9), mixed DLB/AD (n ϭ 57), and pure AD (n ϭ 66). Factor analysis was used to recover latent constructs in a comprehensive psychometric test battery, analysis of variance was used to test group differences on the observed dimensions, and random effects models were used to test longitudinal rates of cognitive decline. Results: Patients with AD pathology performed worse on the verbal memory dimension. Patients with LB pathology performed worse on the visuospatial dimension. Combined pathology affected visuospatial performance but not verbal memory. The rate of cognitive decline in the DLB, DLB/AD combined, and the pure AD groups was equivalent. Conclusions: The comorbid presence of DLB and AD alters the cognitive presentation of visuospatial deficits in dementia but does not alter dementia progression. Both visuospatial and verbal abilities declined at similar rates across the three patient groups. DLB diagnosis may be improved, particularly when there is comorbid AD, by using domain-specific testing. NEUROLOGY 2005;65:1232-1238 In contrast to the neuritic plaques and neurofibrillary tangles of Alzheimer disease (AD), dementia with Lewy bodies (DLB) is characterized by ␣-synuclein inclusions (i.e., Lewy bodies [LBs]) in neocortical, limbic, and subcortical regions. DLB and associated disorders of ␣-synuclein aggregation (synucleinopathies) are the second most common cause of neurodegenerative dementia after AD.1 Although a minority of DLB cases have only LBs at autopsy ("pure" DLB), the more common finding is a mixture of LBs with sufficient burden of neuritic plaques and neurofibrillary tangles to also diagnose AD (mixed DLB/AD). The reverse is also true, as LBs are observed frequently in AD. A review of autopsied cases from the Washington University Alzheimer Disease Research Center (ADRC) suggests that as many as 25% of autopsied AD cases have cortical/ limbic LBs in sufficient quantity to be classified as mixed DLB/AD, although most did not clinically manifest the distinctive symptoms of DLB.2,3 Other autopsy series confirm the high co-occurrence of DLB and AD. 4,5 Although there are published criteria for the clinical features of DLB, 3 these criteria appear to best capture the "pure" DLB cases. It is unclear how well the criteria capture the more common mixed DLB/AD group, many of whom may be misclassified clinically as probable AD.1 Diagnostic criteria for DLB include progressive cognitive decline plus at least two of the following: parkinsonism, visual hallucinations, or cognitive fluctuation. 3 Becaus...

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confidence: 78%

Verbal and visuospatial deficits in dementia with Lewy bodies

2005

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“…Thus, heterogeneous pathological processes may exist in MCI patients, who then experience different cognitive dysfunction patterns. Different cognitive profiles are also associated with different prognoses, with episodic memory impairment regarded as a predictor of development of AD [35,39,40], whilst working memory impairment is more strongly associated with the onset of other types of dementia, such as vascular dementia and Lewy body dementia [41,42,43,44,45]. …”

Section: Discussionmentioning

confidence: 99%

Predictors of Future Cognitive Decline in Persons with Mild Cognitive Impairment

Xie

Mayo

Koski

2011

Dement Geriatr Cogn Disord

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This study sought first to identify individual items of the Mini-Mental State Examination (MMSE) and demographic variables at baseline that predicted the trajectories of cognitive change among patients with mild cognitive impairment (MCI), and second to quantify the risk of cognitive decline in such patients based on their pattern of failure of MMSE items. 187 MCI patients were evaluated serially with the MMSE for up to 3.5 years. Patients who followed a declining cognitive trajectory differed from the stable reference group in their baseline profile of MMSE test performance. Patient age and performance on delayed recall, constructional praxis, attention, and orientation to time and floor predicted future cognitive decline with good accuracy (79.9%) and specificity (86.4%), and moderate sensitivity (67.2%). These results are presented in the form of a simple clinical tool for quantifying risk of future cognitive decline in MCI.

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“…This was shown in a study that directly compared the performance of patients with autopsy-confirmed DLB (all with concomitant AD pathology) or with pure AD on the CVLT and the WMS-R logical memory test (Hamilton et al 2004). Although the two groups were equally impaired in their ability to learn new verbal information on these tests, the DLB patients exhibited better retention and better recognition memory than patients with pure AD.…”

Section: Alzheimer Disease Versus Dementia With Lewy Bodiesmentioning

confidence: 92%

The Neuropsychological Profile of Alzheimer Disease

Weıntraub

Wicklund²,

Salmon³

2012

Cold Spring Harbor Perspectives in Medicine

456

282

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Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from "normal," age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease.O ver the past 30 years, neuropsychological assessment has featured centrally in characterizing the dementia associated with Alzheimer disease (AD), identifying the most salient and earliest cognitive and behavioral symptoms and contributing to the staging and tracking of disease (Flicker et al. 1984;Morris et al. 1989;Storandt and Hill 1989;Storandt 1991;Welsh et al. 1991Welsh et al. , 1992Locascio et al. 1995;Albert 1996;Storandt et al. 1998; see also Salmon and Bondi 2009). As research has increasingly focused on earlier stages of illness, it has become clear that biological markers of AD can precede cognitive and behavioral symptoms by years. It has also become clear that the early symptoms of AD represent the selective targeting by disease of specific, "largescale" neuroanatomical networks, with clinical deficits consistent with the anatomical locus of impact (Weintraub and Mesulam 1993Seeley et al. 2009). In the usual case, AD pathology is initially selective for limbic regions that subserve episodic memory, which leads to a circumscribed memory deficit in the early stages of the disease (Braak and Braak 1991;Jack et al. 1997; de ToledoMorrell et al. 2000). It is only as pathology progresses to other neocortical regions over time (Braak and Braak 1996a,b;Braak et al. 1999;Jack et al. 2000) that additional cognitive symptoms emerge and the full dementia syndrome becomes apparent.These discoveries have prompted a revision of the established research diagnostic criteria for AD dementia that had served so well since 1984 (McKhann et al. 1984). The new criteria define not only the dementia of AD (McKhann et al. 2011) but also incorporate a fuller spectrum of cognitive aging, including an intermediate stage of mild cognitive impairment (MCI) that precedes the dementia (Albert et al. 2011). A third, even earlier, stage of "preclinical AD" has also been identified (Sperling et al. 2011). This prodromal period is characterized by the presence of bi...

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A comparison of episodic memory deficits in neuropathologically-confirmed Dementia with Lewy bodies and Alzheimer's disease

Cited by 85 publications

References 48 publications

Verbal and visuospatial deficits in dementia with Lewy bodies

Verbal and visuospatial deficits in dementia with Lewy bodies

Predictors of Future Cognitive Decline in Persons with Mild Cognitive Impairment

The Neuropsychological Profile of Alzheimer Disease

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