Elderly people with gait disorder in Lewy body diseases, white matter diseases, and their combination: A neuroimaging‐assisted analysis

Abstract

Aim of study: While Lewy body diseases (LBDs, comprising Parkinson's disease, dementia with Lewy bodies) and white matter diseases (WMD) coexist pathologically, it is uncertain to what extent each disease and the combination of the two manifests clinically, particularly regarding gait disorders. To answer this question, we performed neuroimaging-assisted analysis. Methods:This was a retrospective cohort study (215 patients with gait, cognitive, or sleep-autonomic disorders who were referred to our department within a 2-year period). The inclusion criteria were apparent gait disorder; age >65 years; WMD observed on MRI; and LBD observed on both DAT and MIBG for clarity. Results:We had 39 patients with LBD; 31 with WMD; and 52 with dual diseases.The types of motor disorder in LBD varied (purely akinetic, akineto-rigid, and tremor forms), whereas in WMD it was purely akinetic with a wide-based gait. Those with dual diseases showed a clinical combination of the two. Cognitive disorders of LBDonly and of dual diseases were more severe than WMD only. Sleep disorder and postural hypotension occurred only in LBD-only and in dual diseases; constipation was common in LBD and dual groups. However, none of the differences reached statistical significance. Conclusion:Among the patients, 23%-50% of LBD and those of dual diseases had the purely akinetic form, which might be indistinguishable from WMD. In such cases, additional motor (subtle upper-half akinesia, abnormal posture) and nonmotor (cognitivesleep-autonomic) signatures may help in diagnosing (comorbid) LBD cases that require treatment.

Autonomic dysfunction in older individuals: The contributions of multiple brain diseases and diabetes

“…31 Sleep disturbance in DLB and PD is characterized by rapid eye movement (REM)-sleep behavior disorder as sleep walking and dream enactment behaviors (vivid, intense, and sometimes violent) occur during REM sleep due to impairment of muscle inhibitory mechanisms. 33 Overactive bladder symptom occurs in 60% of PD cases and in 70%-80% of DLB cases, and its severity is also more severe in DLB compared to PD, and accompanied by urinary incontinence due to small bladder capacity and bladder overactivity more frequently. 34 Parallel with this, severe dementia in DLB also causes functional (secondary to dementia) urinary incontinence, that is, urinary incontinence due to inability to reach toilet by spatial disorientation and/ or loss of initiative, being totally dependent.…”

“…31 Since DLB and PD share the same alpha-synuclein-positive Lewy body pathology, 32 the term "Lewy body disease" has also been used for assigning both diseases. 33 However, regarding movement disorder, DLB shows a lower rate of tremor than PD patients. 33 Individuals with DLB show dementia, showing an MMSE score of 0/30 in the most severe cases.…”

“…33 However, regarding movement disorder, DLB shows a lower rate of tremor than PD patients. 33 Individuals with DLB show dementia, showing an MMSE score of 0/30 in the most severe cases. Unlike AD, the dementia in DLB fluctuates and is often accompanied by visual hallucinations.…”

Hemodialysis and brain diseases in older individuals

“…This was a retrospective study with a 12‐month recruiting period (April 2019 to March 2020), a follow‐up period of 3.0 ± 2.5 (mean ± standard deviation [SD]) weeks, and more than once‐a‐week visit. The inclusion criteria were: (1) inpatient at a multi‐faculty university hospital in Japan, (2) undergoing HD (either started during hospitalization or continuing from out‐patient treatment), and (3) a diagnosis of brain symptoms resulting in a referral to the DST 11 . The referral was made by link nurses who are attached to each hospital ward based on (a) gait difficulty severe enough to require manual assistance or a wheelchair, episodes of fall, aspiration, or (b) dementia/delirium severe enough for a positive score on the Clinical Dementia Rating scale and/or the Confusion Assessment Method.…”

“…Among these, gait 3 and aspiration 4 disorders are typically caused by lesions in the pyramidal and extrapyramidal pathways in the brain, respectively; the frontal cortex and supplemental motor area are also relevant. 3,11 Older individuals under HD show slow gait speed, short steps (indicating parkinsonism) and marked sway/loss of balance (indicating ataxia or neuropathies 3 ). In contrast, memory disorders reflect lesions in the hippocampus and other areas 15 while executive (planning and judgment) disorders reflects lesions in the prefrontal, cingulate and insular cortices, and other areas.…”