Orthostatic Hypotension is Associated with Visuospatial Dysfunction in Lewy Body Dementia (4625)
0
Citation
0
Reference
10
Related Paper
Keywords:
Lewy body
Background Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series. Aims This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences. Method We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions. Results The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v . 0.6 years, P = 0.017), underwent more scans (1.7 v . 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v . 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v . 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging ( P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs. Conclusions Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
Lewy body
Cite
Citations (41)
Abstract Objectives To determine whether orthostatic hypotension (OH) is more common in patients with dementia than in older people without cognitive impairment and to identify key differences in the profile of the orthostatic response and the pulse drive during orthostatic challenge between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Methods The orthostatic response was evaluated in 235 patients with AD, 52 patients with DLB and 62 elderly controls. The blood pressure and pulse rate were measured in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. OH was defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or a reduction of diastolic blood pressure (DBP) of at least 10 mm Hg. Results OH occurred in 69% of the DLB patients and in 42% of the AD patients, but only in 13% of the controls ( p < 0.001 controls vs AD and controls vs DLB, p = 0.001 AD vs DLB) The DLB patients had a greater drop in SBP than the other study groups during orthostatic challenge and had a more prolonged period of orthostasis. The pulse drive on orthostatic challenge was similar in between groups. However, in the DLB group it was not adequate to restore the blood pressure to supine values. Conclusions Patients with DLB react different to orthostatic challenge than patients with AD or controls, with important clinical implications for key disease symptoms and treatment. Copyright © 2007 John Wiley & Sons, Ltd.
Supine position
Pulse pressure
Cite
Citations (47)
Lewy body dementia (LBD) is an umbrella term used to group together the two closely related conditions of dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD). Cortical neuronal Lewy bodies and Lewy neurites are found in both conditions at autopsy. As well as dementia, DLB and PDD also share common clinical features including fluctuations in attention, visual hallucinations and parkinsonism (1,2). If parkinsonism is present one year before the onset of dementia, patients are diagnosed with PDD, if it is less than one year, or it is not present, the diagnosis is DLB.
Lewy body
Lewy body disease
Cite
Citations (0)
Lewy body
Cite
Citations (0)
Lewy body
Lewy body disease
Cite
Citations (0)
<i>Aim:</i> To investigate quality of life (QOL) and the effect of memantine treatment in patients with Lewy body dementias. <i>Methods:</i> A secondary analysis of a randomized controlled study in 70 patients with Parkinson’s disease dementia (PDD) or dementia with Lewy bodies (DLB) over 24 weeks using caregiver-rated QOL-Alzheimer’s disease (AD) in domains according to the WHO’s classification of health. <i>Results:</i> Baseline QOL shows lower ratings for body functions over environmental factors in DLB/PDD. Treatment with memantine significantly improves life as a whole compared to placebo and improves total QOL, body function and structure. <i>Conclusion:</i> This study shows that memantine improves QOL in Lewy body dementias. We also demonstrate important QOL patterns which can be used in clinical practice.
Memantine
Lewy body
Cite
Citations (48)
Lewy body
Neurochemical
Cite
Citations (0)
Lewy body
Neuroradiology
Cite
Citations (37)
Background 123 I-FP-CIT SPECT (single photon emission computed tomography) can help in the differential diagnosis of probable dementia with Lewy bodies (Lewy body dementia) and Alzheimer's disease. Aims Our aim was to determine the accuracy of 123 I-FP-CIT SPECT in diagnosing people with possible dementia with Lewy bodies. Method We undertook a 12-month follow-up of 325 individuals with probable or possible Lewy body or non-Lewy body dementia who had previously undergone 123 I-FP-CIT SPECT. A consensus panel masked to SPECT findings, established diagnosis at 12 months in 264 people. Results Of 44 people with possible dementia with Lewy bodies at baseline, at follow-up the diagnosis for 19 people was probable dementia with Lewy bodies (43%), in 7 people non-Lewy body dementia (16%) and for 18 individuals it remained possible dementia with Lewy bodies (41%). Of the 19 who at follow-up were diagnosed with probable dementia with Lewy bodies, 12 had abnormal scans at baseline (sensitivity 63%); all 7 individuals with a possible diagnosis who were diagnosed as having Alzheimer's disease at follow-up had normal scans (specificity 100%). Conclusions Our findings confirm the diagnostic accuracy of 123 I-FP-CIT SPECT in distinguishing Lewy body from non-Lewy body dementia and also suggest a clinically useful role in diagnostically uncertain cases, as an abnormal scan in a person with possible dementia with Lewy bodies is strongly suggestive of dementia with Lewy bodies.
Lewy body
Lewy body disease
Cite
Citations (136)
Eglė Kymantaitė¹ ¹Vilnius University, Faculty of Medicine Vilnius, Lithuania Abstract Dementia with Lewy body (DLB) is one of the alpha-synucleopathies. The disease is characterized by fluctuating cognitive impairment along with visual hallucinations and symptoms of parkinsonism. Based on clinical symptoms, a probable diagnosis of an DLB is made. There are no specific diagnostic methods. Although much research is being done to find a disease-modifying treatment, therapies that affect the progression of the disease are not yet available. Aim: To select and analyze literature sources related to innovations in the diagnosis and treatment of dementia with Lewy bodies. Methods: The literature review was based on the PubMed, ClinicalKey, and UpToDate databases. The publications were selected using the following keywords in the original language: “Dementia with Lewy bodies” “Diagnosis of dementia with Lewy bodies”, “Treatment of dementia with Lewy bodies”. Exclusion criteria were: language, duplicate articles. Despite efforts to focus on publications from the last 5 years, the citation period was not limited. 59 articles were reviewed, from which 41 articles were selected for further analysis. Results: Dementia with Lewy cells is a progressive disease that affects the central nervous system and is associated with the accumulation of the pathological protein alpha – synuclein. Although there is no treatment that modifies the course of the disease, it is important to diagnose the disease early to improve patients’ quality of life and reduce symptoms. Conclusion: This literature review provides key insights into innovations in the diagnosis and treatment of dementia with Lewy bodies. Keywords: Dementia with Lewy body, Lewy body, alpha-synuclein.
Lewy body
Lewy body disease
Cite
Citations (0)