New evidence on the management of Lewy body dementia

Taylor, John‐Paul; McKeith, Ian; Burn, David J.; Boeve, Brad F.; Weintraub, Daniel; Bamford, Claire; Allan, Louise; Thomas, Alan; O’Brien, John

doi:10.1016/s1474-4422(19)30153-x

Cited by 199 publications

(288 citation statements)

References 115 publications

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“…This finding is important as noncognitive symptoms are potentially treatable. 42 Early diagnosis is mandatory because it can help in managing symptoms and reducing the impact on patients and caregivers.…”

Section: Discussionmentioning

confidence: 99%

Prodromal Dementia With Lewy Bodies: Clinical Characterization and Predictors of Progression

et al. 2020

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A BS TRACT: Objective: The objective of this study was to examine clinical characteristics, cognitive decline, and predictors for time to dementia in prodromal dementia with Lewy bodies with mild cognitive impairment (MCI-LB) compared with prodromal Alzheimer's disease (MCI-AD). Methods: We included 73 MCI-LB patients (12% female; 68 AE 6 years; Mini Mental State Examination, 27 AE 2) and 124 MCI-AD patients (48% female; 68 AE 7 years; Mini Mental State Examination, 27 AE 2) from the Amsterdam Dementia Cohort. Follow-up was available for 61 MCI-LB patients and all MCI-AD patients (3 AE 2 years). We evaluated dementia with Lewy bodies core features, neuropsychiatric symptoms, caregiver burden (Zarit caregiver burden interview), MRI, apolipoprotein genotype, and cerebrospinal fluid biomarkers (tau/Aβ 1-42 ratio). Longitudinal outcome measures included cognitive slopes (memory, attention, executive functions, and language and visuospatial functions) and time to dementia. Results: Parkinsonism was the most frequently present core feature in MCI-LB (69%). MCI-LB patients more often had neuropsychiatric symptoms and scored higher on ZARIT when compared with the MCI-AD patients. Linear mixed models showed that at baseline, MCI-LB patients performed worse on nonmemory cognitive domains, whereas memory performance was worse in MCI-AD patients. Over time, MCI-LB patients declined faster on attention, whereas MCI-AD patients declined faster on the Mini Mental State Examination and memory. Cox proportional hazards regressions showed that in the MCI-LB patients, lower attention (hazard ratio [HR] = 1.6; 95% confidence interval [CI], 1.1-2.3) and more posterior cortical atrophy (HR = 3.0; 95% CI, 1.5-5.8) predicted shorter time to dementia. In the MCI-AD patients, worse performance on memory (HR = 1.1; 95% CI, 1.0-1.2) and executive functions (HR = 1.3; 95% CI, 1.0-1.6) were independently associated with time to Alzheimer's dementia. Conclusion: MCI-LB patients have distinct neuropsychiatric and cognitive profiles with prominent decline in attention when compared with MCI-AD patients. Our results highlight the importance of early diagnosis because symptoms already have an impact in the prodromal stages.

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Section: Discussionmentioning

confidence: 99%

Prodromal Dementia With Lewy Bodies: Clinical Characterization and Predictors of Progression

et al. 2020

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“…The early diagnosis of dementia is becoming increasingly important as it is likely that potential diseasemodifying treatments will have their greatest effect at this stage. Additionally, accurate and early differential diagnosis of dementia subtypes is crucial for correct patient strati cation for clinical trials and research studies and for optimizing clinical care such as by highlighting the need to carefully avoid using medication with anticholinergic properties and encouraging active identi cation of therapeutic targets such as orthostatic hypotension and constipation [1].…”

Section: Introductionmentioning

confidence: 99%

Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies

Schumacher

Taylor

Hamilton

et al. 2020

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Objectives: To investigate using quantitative EEG (1) differences between patients with mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with Alzheimer’s disease (MCI-AD) and (2) its utility as a potential biomarker for early differential diagnosis. Methods: We analyzed eyes-closed, resting state, high-density EEG data from highly phenotyped participants (39 MCI-LB, 36 MCI-AD, and 31 healthy controls). EEG measures included spectral power in different frequency bands (delta, theta, pre-alpha, alpha, and beta), theta/alpha ratio, dominant frequency, and dominant frequency variability. Receiver operating characteristics (ROC) analyses were performed to assess diagnostic accuracy. Results: There was a shift in power from beta and alpha frequency bands towards slower frequencies in the pre-alpha and theta range in MCI-LB compared to healthy controls. Additionally, dominant frequency was slower in MCI-LB compared to controls. We found significantly increased pre-alpha power, decreased beta power, and slower dominant frequency in MCI-LB compared to MCI-AD. EEG abnormalities were more apparent in MCI-LB cases with more diagnostic features. There were no significant differences between MCI-AD and controls. In the ROC analysis to distinguish MCI-LB from MCI-AD, beta power and dominant frequency showed the highest area under the curve values of 0.71 and 0.70, respectively. While specificity was high for some measures (up to 0.97 for alpha power and 0.94 for theta/alpha ratio), sensitivity was generally much lower. Conclusions: Early EEG slowing is a specific feature of MCI-LB compared to MCI-AD. However, there is overlap between the two MCI groups which makes it difficult to distinguish between them based on EEG alone.

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“…The effectiveness of cholinesterase inhibitors, such as donepezil and galantamine, in cognition, global function, and visual hallucinations in DLB has been demonstrated in several studies (4,(34)(35)(36), and the effectiveness of donepezil in post-stroke aphasia has been established in a randomized placebo-controlled study (37). In addition, the effectiveness of galantamine in PPA patients with unspecified subtypes was investigated in 18-weeks open-label and 8-weeks randomized placebo-controlled studies, and language function remained stable in some of the galantamine-treated PPA patients compared with placebo-treated patients (38)(39)(40).…”

Section: Discussionmentioning

confidence: 99%

Primary Progressive Aphasia as a Prodromal State of Dementia With Lewy Bodies: A Case Report

2020

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Dementia with Lewy bodies (DLB) is the second most common form of dementia in the elderly, and various clinical symptoms, including olfactory dysfunction, dysautonomia, depression, and rapid eye movement sleep behavior disorders (RBD), occur in patients with the prodromal state of DLB. We herein describe a case of a 72-years-old right-handed woman who exhibited primary progressive aphasia (PPA) as a prodromal state of DLB and took cholinesterase inhibitors (donepezil). At 4.5 years after aphasia onset, she exhibited all the core clinical features of DLB, including visual hallucinations, fluctuating cognition, RBD, and Parkinsonism, as well as progressive language impairment. She showed reduced dopamine transporter (DAT) uptake (assessed by DAT single-photon emission computed tomography imaging) in the striatum and decreased cardiac uptake (determined by 123 I-metaiodobenzylguanidine myocardial scintigraphy), which are indicative biomarkers of DLB. Thus, this patient met all the criteria for probable DLB. Notably, the unique feature of this case was the presentation of PPA, which is seldom observed in typical DLB. Moreover, cholinergic enhancement (donepezil, 5 mg daily) improved her language function and global cognitive function, although mild aphasia remained. The findings provide valuable insights into the spectrum of the prodromal state of DLB and shed light on the development of the medication for PPA caused by cholinergic insufficiency.

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New evidence on the management of Lewy body dementia

Cited by 199 publications

References 115 publications

Prodromal Dementia With Lewy Bodies: Clinical Characterization and Predictors of Progression

Prodromal Dementia With Lewy Bodies: Clinical Characterization and Predictors of Progression

Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies

Primary Progressive Aphasia as a Prodromal State of Dementia With Lewy Bodies: A Case Report

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