Our Parkinson's Place: Trial Helps Doctors Tell Lewy Body Dementia From Alzheimer’s and Parkinson’s

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Sunday, September 25, 2016

Trial Helps Doctors Tell Lewy Body Dementia From Alzheimer’s and Parkinson’s

NEUROSCIENCE NEWSSEPTEMBER 25, 2016

Summary: A new study reports on how the clinical profiles of Lewy body dementia differ from Alzhiemer’s or Parkinson’s disease.

Source: Ohio State University.

Lewy body dementia is characterized by Parkinsonism (stiffness and trouble with gait), memory loss, and visual processing difficulties. Fluctuations and visual hallucinations are not uncommon. Mental degradation progresses as in people with Alzheimer’s disease. The disease usually appears after age 60. Neurosciencenews image is for illustrative purposes only.

Knowing that many clinicians find it difficult to correctly diagnose patients with Lewy body dementia, researchers at The Ohio State University Wexner Medical Center set out to develop a clinical profile for these patients. Their findings are published online in the Journal of Alzheimer’s Disease.

The study compared 21 patients with Lewy body dementia to 21 patients with Alzheimer’s disease and 21 patients with Parkinson’s disease. The patients were carefully matched by age, gender, education, race, degree of cognitive impairment, and degree of motor (physical) impairment. Pairs were compared using cognitive, functional, behavioral and motor measures.

“Many clinicians find it difficult to diagnose Lewy body dementia patients, often confusing them and misdiagnosing them as Alzheimer¹s disease or Parkinson¹s disease patients. Our study findings showed that the clinical profiles of Lewy body dementia patients can be differentiated from Alzheimer’s and Parkinson’s patients,” said Dr. Douglas Scharre, director of the division of cognitive neurology at Ohio State’s Wexner Medical Center and principal investigator of the study. “Since treatments and prognosis differ between these conditions, it’s important to correctly diagnose the patient from the start.”

Researchers with Ohio State’s Center for Cognitive and Memory Disorders found that the diagnosis is likely Lewy body dementia if the patient is characterized by a specific cognitive profile (retrieval memory disturbance and deficits in visuospatial and executive domains), along with axial (trunk/body) posture impairments & gait/balance instability. Compared to Alzheimer’s patients, Lewy body dementia patients have more executive and visuospatial deficits and less amnesia and disorientation, and also show more daytime sleepiness, cognitive/behavioral fluctuations, hallucinations and obstructive sleep apnea than either Alzheimer’s or Parkinson’s patients. Significant correlations were noted between axial motor, balance and gait disturbances and executive functioning, visuospatial abilities and global cognitive deficits.

Lewy bodies are collections of proteins (alpha-synuclein) that accumulate abnormally in the brain, that are not typically seen in Alzheimer’s, and are deposited in different parts of the brain than in Parkinson’s. These toxic alpha-synuclein proteins accumulate gradually, impact specific brain regions leading to its unique clinical symptoms and disease course, and need to be treated and managed differently than those with Alzheimer’s or Parkinson’s.

“It’s vitally important that patients are correctly diagnosed so that they can be prescribed the proper medications that may help slow down the course of the disease or improve symptoms,” Scharre said. The correct diagnosis of Lewy body dementia will prompt evaluation and treatment for commonly co-existing associated conditions such as autonomic conditions, sleep apnea, REM sleep behavior disorder, fluctuations of attention and alertness, gait disturbance and fall risk.

ABOUT THIS NEUROLOGY RESEARCH ARTICLE

Funding: This research is supported by a grant from the Mangurian Foundation.

Source: Eileen Scahill – Ohio State University
Image Source: This NeuroscienceNews.com image is for illustrative purposes only.

Original Research: Full open access research for “Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases” by Scharre, Douglas W.; Chang, Shu-Ing; Nagaraja, Haikady N.; Park, Ariane; Adeli, Anahita; Agrawal, Punit; Kloos, Anne; Kegelmeyer, Deb; Linder, Shannon; Fritz, Nora; Kostyk, Sandra K.; and Kataki, Maria in Journal of Alzheimer’s Disease. Published online June 26 2016 doi:10.3233/JAD-160384

Abstract

Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases

Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer’s disease (AD) and Parkinson’s disease (PD). Twenty-one mildly demented ambulatory LBD subjects were individually matched by MMSE score with 21 AD subjects and by UPDRS motor score with 21 PD subjects. Matched by age, gender, education, and race, pairs were compared using cognitive, functional, behavioral, and motor measures. LBD group performed worse than PD on axial motor, gait, and balance measures. AD had more amnesia and orientation impairments, but less executive and visuospatial deficits than LBD subjects. LBD group had more sleepiness, cognitive/behavioral fluctuations, hallucinations, and sleep apnea than AD or PD. Axial motor, gait, and balance disturbances correlated with executive, visuospatial, and global cognition deficits. LBD is differentiated from AD and PD by retrieval memory, visuospatial, and executive deficits; axial motor, gait and balance impairments; sleepiness, cognitive/behavioral fluctuations, hallucinations, and sleep apnea.

“Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases” by Scharre, Douglas W.; Chang, Shu-Ing; Nagaraja, Haikady N.; Park, Ariane; Adeli, Anahita; Agrawal, Punit; Kloos, Anne; Kegelmeyer, Deb; Linder, Shannon; Fritz, Nora; Kostyk, Sandra K.; and Kataki, Maria in Journal of Alzheimer’s Disease. Published online June 26 2016 doi:10.3233/JAD-160384

http://neurosciencenews.com/alzheimers-lewy-body-parkinsons-5123/