Differentiating Dementia with Lewy Bodies from Alzheimer's Disease Using the Fall Risk Evaluation Questionnaire

Abstract

Objective Dementia with Lewy bodies (DLB) is the second-most common form of neurodegenerative dementia after Alzheimer's disease (AD). Falls are a vital prognostic factor in patients with dementia and are a characteristic feature of DLB. This study investigated the screening potential of the fall risk evaluation for DLB and compared it with that of AD to facilitate an accurate diagnosis. Methods We enrolled patients diagnosed with DLB (n = 410) and AD (n = 2,683) and categorized the participants into 3 groups depending on their physical ability, age, cognitive function, and fall events. Using the Fall Risk Index-21 (FRI-21) questionnaire, we evaluated and comparatively analyzed the fall risk between DLB and AD patients in three defined groups of participants. ResultsThe FRI-21 score was significantly higher in DLB patients than in AD patients in every group. Using this score, we were able to distinguish between DLB and AD patients in each group. Among the three groups, the group with a young age, relatively mild cognitive dysfunction, and no fall events exhibited the best specificity for DLB (0.895). Conclusions The FRI-21 is a useful tool for screening for DLB and differentiating it from AD. This questionnaire can be used at a relatively early stage of the disease in young patients with mild cognitive dysfunction and no history of falling. These preliminary results need to be validated in an interventional study to evaluate the effectiveness of rehabilitative measures and daily environmental changes carried out to prevent falls using this tool.

Differences in fall-related characteristics across cognitive disorders

“…While DLB is known to affect several different brain regions, to our knowledge no studies have been performed to evaluate the underlying etiology of neural substrates in relation to falls. Despite this lack of knowledge, the Fall Risk Index-21 (FRI-21) has shown efficacy in screening for DLB and differentiating from AD (Tsujimoto et al, 2021). Surprisingly, despite a high frequency of falls in DLB, no specific prevention strategies have been presented.…”

Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer’s Disease and Mild Cognitive Impairment

“…All included studies tracked fall prevalence or the number of fallers during a 12-month period (either retrospectively or prospectively). The sample size varied significantly, from 14 [ 40 ] to 2490 [ 44 ] for AD studies and from 16 [ 56 ] to 938 [ 49 ] for MCI studies. The number of falls over a 12-month duration was available for five MCI studies [ 12 , 14 , 52 , 53 , 59 ] and nine AD studies [ 14 , 31 – 33 , 35 , 40 , 46 , 47 , 59 ].…”

Brexpiprazole Can Be Used to Treat Behavioral and Psychological Symptoms of Lewy Body Dementia Without Exacerbating the Risk of Falls

“…Patients with DLB often have increased sensitivity to neuroleptic medications, leading to falls and autonomic dysfunction, a concern for both patients and health care providers. 5…”