Dementia and Geriatric Cognitive Disorders
Original Research Article
Clinical Diagnosis of Dementia with Lewy Bodies in a Japanese Dementia RegistryImamura T. · Hirono N. · Hashimoto M. · Shimomura T. · Tanimukai S. · Kazui H. · Hanihara T. · Mori E.Division of Clinical Neurosciences, Hyogo Institute for Aging Brain and Cognitive Disorders, Himeji, Japan
|
|
Log in to MyKarger to check if you already have access to this content.
KAB
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price.
Article / Publication Details
Published online: May 11, 1999
Issue release date: May – June
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3
ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)
For additional information: https://www.karger.com/DEM
Abstract
We found 15 patients with dementia with Lewy bodies (DLB) and 232 patients with Alzheimer’s disease (AD) among 327 consecutive patients with mild to moderate dementia in a Japanese dementia registry, using the clinical criteria of the Consortium on DLB International Workshop. The percentage of females was significantly lower in DLB than in AD (p < 0.01), while age at examination, Mini-Mental State Examination score and duration of cognitive symptoms were comparable between the two diseases. Eight of the 15 DLB patients (53%) had spontaneous parkinsonism, which was observed in 6 of the 232 AD patients (2.6%). Visual hallucinations were reported by 11 of the 15 DLB patients (73%) and 8 of the 232 AD patients (3.4%). Cognitive fluctuation was positive in 13 of the 15 DLB patients (87%). We found two types of episodic cognitive deterioration: one was characterized by pronounced disturbances of attention and alertness (inattention type), and the other was characterized by marked and bizarre disturbances of orientation in time and places, and misidentification of persons (disorientation type). Systematized delusion was observed in 8 DLB patients, and 5 patients showed neuroleptic sensitivity. Patients with DLB have a unique dementia syndrome even in the stage of mild to moderate cognitive impairments. Further studies are recommended to establish diagnosis, treatment and management.
Related Articles:
References
- Kosaka K: Diffuse Lewy body disease in Japan. J Neurol 1990;237:197–204.
- Perry RH, Irving D, Blessed G, Fairbairn A, Perry EK: Senile dementia of Lewy body type: A clinically and neuropathologically distinct form of Lewy body dementia in the elderly. J Neurol Sci 1990;95:119–139.
-
Hansen L, Salmon D, Galasko D, Masliah E, Katzman, Alford M: The Lewy body variant of Alzheimer’s disease: A clinical and pathological entity. Neurology 1990;40:1–8.
External Resources
- McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Low J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen ENH, Ballard C, de Vos RAI, Wilcock GK, Jellinger KA, Perry RH: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the Consortium on DLB International Workshop. Neurology 1996;47:1113–1124.
- Mega MS, Masterman DL, Benson DF, Vinters HV, Tomiyama U, Craig AH, Foti DJ, Kaufer D, Scharre DW, Fairbanks L, Cummings JL: Dementia with Lewy bodies: Reliability and validity of clinical and pathological criteria. Neurology 1996;47:1403–1409.
- Galasko D, Hansen LA, Katzman R, Wiederholt W, Masliah E, Terry R, Hill LR, Lessin P, Thal LJ: Clinical-neuropathological correlations in Alzheimer’s disease and related dementias. Arch Neurol 1994;51:888–895.
- Ince PG, McArthur FK, Bjertness E, Torvik A, Candy JM, Edwardson LA: Neuropathological diagnosis in elderly patients in Oslo: Alzheimer’s disease, Lewy body disease, vascular lesions. Dementia 1995;6:162–168.
- Hulette C, Mirra S, Wilkinson W, Heyman A, Fillenbaum G, Clark C: The consortium to establish a registry for Alzheimer’s disease (CERAD). IX. A prospective cliniconeuropathologic study of Parkinson’s features in Alzheimer’s disease. Neurology 1995;45:1991–1995.
-
Kosaka K, Iseki E: Diffuse Lewy body disease within the spectrum of Lewy body disease; in Perry RH, McKeith IG, Perry EK (eds): Dementia with Lewy Bodies. Cambridge, Cambridge University Press, 1996, pp 238–247.
- Liberini P, Valerio A, Memo M, Spano PF: Lewy-body dementia and responsiveness to cholinesterase inhibitors: A paradigm for heterogeneity of Alzheimer’s disease? Trends Pharmacol Sci 1996;17:155–160.
-
Perry EK, Perry RH: Altered consciousness and transmitter signaling in Lewy body dementia; in Perry RH, McKeith IG, Perry EK (eds): Dementia with Lewy Bodies. Cambridge, Cambridge University Press, 1996, pp 397–413.
-
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
- Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–572.
-
Morris JC: The clinical dementia rating (CDR): Current version and scoring rules. Neurology 1993;43:2412–2414.
- Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
- Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.
-
Hirono N, Mori E, Ikejiri Y, Imamura T, Shimomura T, Hashimoto M, Yamashita H, Ikeda M: Japanese version of the Neuropsychiatric Inventory: A scoring system for neuropsychiatric disturbances in dementia patients (in Japanese). No To Shinkei (Brain Nerve) 1997;49:266–271.
- McKhann G, Drachman D, Folstein M, Katzman R, Price D, Standlan EM: Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
- The Lund and Manchester Groups: Clinical and neuropathological criteria for frontotemporal dementia. J Neurol Neurosurg Psychiatry 1994;57:416–418.
-
Lees AJ: The Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Mov Disord 1987;2:272–287.
-
Lang AE, Riley DE, Bergeron C: Cortical-basal ganglionic degeneration; in Calne DB (ed): Neurodegenerative Disease. Philadelphia, Saunders, 1994, pp 877–894.
- Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R: Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centers. Neurology 1992;42:473–480.
- Román CG, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM, O’Brien MD, Yamaguchi T, Grafman J, Drayer BP, Bennett DA, Fisher M, Ogata J, Kokmen E, Bermejo F, Wolf PA, Gorelick PB, Bick KL, Pajeau AK, Bell MA, DeCarli C, Culebras A, Korczyn AD, Bogousslavsky J, Hartmann A, Scheinberg P: Vascular dementia: Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250–260.
- Imamura T, Ishii K, Sasaki M, Kitagaki H, Yamaji S, Hirono N, Shimomura T, Hashimoto M, Tanimukai S, Kazui H, Mori E: Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease: A comparative study using positron emission tomography. Neurosci Lett 1997;235:49–52.
-
Hirono N, Mori E, Imamura T, Shimomura T, Hashimoto M: Neuropsychiatric features in dementia with Lewy bodies and Alzheimer’s disease (in Japanese). No To Shinkei (Brain Nerve) 1998;50:45–49.
-
Lipowski ZI: Delirium: Acute Brain Failure in Man. Springfield, Thomas, 1980.
-
Burns A, Luthert P, Lewy R, Jacoby R, Lantos P: Accuracy of clinical diagnosis of Alzheimer’s disease. Br Med J 1990;301:1026.
- Drach LM, Steinmetz HE, Wach S, Bohl J: High proportion of dementia with Lewy bodies in the postmortems of a mental hospital in Germany. Int J Geriatr Psychiatry 1997;12:301–306.
- Byrne E, Lennox G, Lowe J, Godwin-Austien RB: Diffuse Lewy body disease: Clinical features in 15 cases. J Neurol Neurosurg Psychiatry 1989;52:709–717.
- Hely MA, Reid WGJ, Halliday GM, McRitchie DA, Leicester J, Joffe R, Brooks W, Broe GA, Morris JGL: Diffuse Lewy body disease: Clinical features in nine cases without coexisting Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1996;60:531–538.
- Burkhardt CR, Filley CM, Kleinschmidt-DeMasters BK, de la Monte S, Norenberg MD, Schneck SA: Diffuse Lewy body disease and progressive dementia. Neurology 1988;38:1520–1528.
- Weiner MF, Risser RC, Cullum CM, Honig L, White C, Speciale S, Rosenberg RN: Alzheimer’s disease and its Lewy body variant: A clinical analysis of postmortem verified cases. Am J Psychiatry 1996;153:1269–1273.
- Ala TA, Yang KH, Sung JH, Frey WH: Hallucinations and signs of parkinsonism help distinguish patients with dementia and cortical Lewy bodies from patients with Alzheimer’s disease at presentation: A clinicopathological study. J Neurol Neurosurg Psychiatry 1997;62:16–21.
- Louis ED, Klatka LA, Liu Y, Fahn S: Comparison of extrapyramidal features in 31 pathologically confirmed cases of diffuse Lewy body disease and 34 pathologically confirmed cases of Parkinson’s disease. Neurology 1997;48:376–380.
- Gnanalingham KK, Byrne EJ, Thornton A, Sambrook MA, Bannister P: Motor and cognitive function in Lewy body dementia: Comparison with Alzheimer’s disease and Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997;62:243–252.
-
Huff FJ, Belle SH, Youn KS, Ganguli M, Boller F: Prevalence and prognostic value of neurologic abnormalities in Alzheimer’s disease. Dementia 1990;1:32–40.
- Lopez OL, Becker JT, Brenner RP, Rosen J, Bajulaiye OI, Reynolds CF: Alzheimer’s disease with delusions and hallucinations: Neuropsychological and electroencephalographic correlates. Neurology 1991;41:906–912.
- Lerner AJ, Koss E, Patterson MB, Ownby RL, Hedara P, Friedland RP, Whitehouse PJ: Concomitants of visual hallucinations in Alzheimer’s disease. Neurology 1994;44:523–527.
- McKeith IG, Perry RH, Fairbairn AF, Jabeen S, Perry EK: Operational criteria for senile dementia of Lewy body type (SDLT). Psychol Med 1992;22:911–922.
- Diesfeldt HFA, Troost D: Delusional misidentification and subsequent dementia: A clinical and neuropathological study. Dementia 1995;6:94–98.
-
Ballard C, Lowery K, Harrison R, McKeith IG: Noncognitive symptoms in Lewy body dementia; in Perry RH, McKeith IG, Perry EK (eds): Dementia with Lewy Bodies. Cambridge, Cambridge University Press, 1996, pp 67–84.
-
McKeith IG, Fairbairn AF, Perry RH, Thompson P, Perry EK: Neuroleptic sensitivity in patients with senile dementia of Lewy body type. Br Med J 1992;305:673–678.
- Geroldi C, Frisoni GB, Bianchetti A, Trabucchi M: Drug treatment in Lewy body dementia. Dement Geriatr Cogn Disord 1997;8:188–197.
- Allen RL, Walker Z, D’Ath PJ, Katona CLE: Risperidone for psychotic and behavioural symptoms in Lewy body dementia. Lancet 1995;346:185.
- Ishii K, Imamura T, Sasaki M, Yamaji S, Sakamoto S, Kitagaki H, Hashimoto M, Hirono N, Shimomura T, Mori E: Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease. Neurology 1998;51:125–130.
- Hashimoto M, Kitagaki H, Imamura T, Hirono N, Shimomura T, Kazui H, Tanimukai S, Hanihara T, Mori E: Medial temporal and whole-brain atrophy in dementia with Lewy bodies: A volumetric MRI study. Neurology 1998;51:357–362.
Article / Publication Details
Published online: May 11, 1999
Issue release date: May – June
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3
ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)
For additional information: https://www.karger.com/DEM
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Get Permission