| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Neurosciences (Drs. Olichney, Galasko, and Thal), University of California, San Diego and San Diego Veteran's Affairs Medical Center; and the Department of Neurosciences (Drs. Salmon, Hansen, and Katzman) and the Alzheimer's Disease Research Center (Dr. Hofstetter), University of California, San Diego, La Jolla, CA.
Address correspondence and reprint requests to Dr. John Olichney, VA Medical Center, Neurology Division (127), 3350 La Jolla Village Drive, San Diego, CA 92161.
Objectives: To quantify the rate of cognitive decline on the Mini-Mental State Examination (MMSE) in autopsy-diagnosed Lewy body variant (LBV) of Alzheimer's disease (AD) cases. We hypothesized that LBV patients would have a faster cognitive decline and shorter survival compared with patients with pure AD.
Background: Prior reports have shown extrapyramidal signs to be associated with a poorer prognosis in AD. It has been suggested that LBV is often characterized by a rapidly progressive course. Few data are available regarding the rate of cognitive decline in autopsy-confirmed LBV dementia cases.
Methods: We searched the databases of the University of California-San Diego Alzheimer's Disease Research Center and the Consortium to Establish a Registry in Alzheimer's Disease (CERAD) for dementia cases with 1) an autopsy diagnosis of definite or probable AD (CERAD criteria) with concomitant Lewy bodies and 2) longitudinal MMSE assessments. This resulted in a series of 40 LBV cases and 148 AD cases without Lewy bodies, with comparable baseline MMSE scores, age, and education. The rate of cognitive decline was calculated as the baseline MMSE - final MMSE. Methods were devised to reduce floor effects on the MMSE.
Results: The average rate of cognitive decline was -5.8 ± 4.5 points/y in LBV and -4.1 ± 3.0 points/y in AD (t-test, p< 0.01). The LBV group declined a similar amount on the MMSE (means, -10.0 versus -9.6 points) over a significantly shorter time interval (1.9 versus 2.7 years; p = 0.005) than did AD patients. At baseline, the mean MMSE scores were nearly identical (18.2 in LBV; 17.8 in AD), but on follow-up examinations approximately 1, 2, and 3 years later, there were intergroup mean differences of 1.8 points (two-tailed p = 0.19), 4.2 points (p = 0.04), and 5.6 points (p = 0.03), respectively. The LBV cases had shorter survival time from the onset of cognitive symptoms (7.7 ± 3.0 years versus 9.3 ± 3.5 years; p = 0.007) and a shorter mean survival after entry/baseline, which was of marginal significance (3.6 versus 4.1 years; p = 0.11).
Conclusions: This study demonstrates that LBV is characterized by a faster cognitive decline and accelerated mortality compared with AD.
Supported by NIH grants AG 05131 and AG 12963, and the Department of Veterans Affairs.
Presented in part at the 49th annual meeting of the American Academy of Neurology, Boston, MA, April 15, 1997.
This article has been cited by other articles:
|
|
 |
|
  M. I. Kester, A. E. van der Vlies, M. A. Blankenstein, Y.A.L. Pijnenburg, E. J. van Elk, P. Scheltens, and W. M. van der Flier CSF biomarkers predict rate of cognitive decline in Alzheimer disease Neurology, October 27, 2009; 73(17): 1353 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. T. Nelson, R. J. Kryscio, G. A. Jicha, E. L. Abner, F. A. Schmitt, L. O. Xu, G. Cooper, C. D. Smith, and W. R. Markesbery Relative preservation of MMSE scores in autopsy-proven dementia with Lewy bodies Neurology, October 6, 2009; 73(14): 1127 - 1133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Bonanni, A. Thomas, P. Tiraboschi, B. Perfetti, S. Varanese, and M. Onofrj EEG comparisons in early Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease with dementia patients with a 2-year follow-up Brain, March 1, 2008; 131(3): 690 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Williams, C. Xiong, J. C. Morris, and J. E. Galvin Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease Neurology, December 12, 2006; 67(11): 1935 - 1941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Tsuang, K. Simpson, E. B. Larson, E. Peskind, W. Kukull, J. B. Bowen, W. McCormick, L. Teri, T. Montine, M. L. Thompson, et al. Predicting lewy body pathology in a community-based sample with clinical diagnosis of Alzheimer's disease. J Geriatr Psychiatry Neurol, December 1, 2006; 19(4): 195 - 201. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Stavitsky, A. M. Brickman, N. Scarmeas, R. L. Torgan, M.-X. Tang, M. Albert, J. Brandt, D. Blacker, and Y. Stern The progression of cognition, psychiatric symptoms, and functional abilities in dementia with lewy bodies and Alzheimer disease. Arch Neurol, October 1, 2006; 63(10): 1450 - 1456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J Burn, E N Rowan, L M Allan, S Molloy, J T O'Brien, and I G McKeith Motor subtype and cognitive decline in Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies J. Neurol. Neurosurg. Psychiatry, May 1, 2006; 77(5): 585 - 589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Tiraboschi, D. P. Salmon, L. A. Hansen, R. C. Hofstetter, L. J. Thal, and J. Corey-Bloom What best differentiates Lewy body from Alzheimer's disease in early-stage dementia? Brain, March 1, 2006; 129(3): 729 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Holtzer, M. C. Irizarry, J. Sanders, B. T. Hyman, D. J. Wegesin, A. Riba, J. Brandt, M. Albert, and Y. Stern Relation of Quantitative Indexes of Concurrent {alpha}-Synuclein Abnormalities to Clinical Outcome in Autopsy-Proven Alzheimer Disease Arch Neurol, February 1, 2006; 63(2): 226 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I Masse, R Bordet, D Deplanque, A Al Khedr, F Richard, C Libersa, and F Pasquier Lipid lowering agents are associated with a slower cognitive decline in Alzheimer's disease J. Neurol. Neurosurg. Psychiatry, December 1, 2005; 76(12): 1624 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Kraybill, E. B. Larson, D. W. Tsuang, L. Teri, W. C. McCormick, J. D. Bowen, W. A. Kukull, J. B. Leverenz, and M. M. Cherrier Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both Neurology, June 28, 2005; 64(12): 2069 - 2073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Scarmeas, M. Albert, J. Brandt, D. Blacker, G. Hadjigeorgiou, A. Papadimitriou, B. Dubois, M. Sarazin, D. Wegesin, K. Marder, et al. Motor signs predict poor outcomes in Alzheimer disease Neurology, May 24, 2005; 64(10): 1696 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Burns, J. E. Galvin, C. M. Roe, J. C. Morris, and D. W. McKeel The pathology of the substantia nigra in Alzheimer disease with extrapyramidal signs Neurology, April 26, 2005; 64(8): 1397 - 1403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Scarmeas, G. M. Hadjigeorgiou, A. Papadimitriou, B. Dubois, M. Sarazin, J. Brandt, M. Albert, K. Marder, K. Bell, L. S. Honig, et al. Motor signs during the course of Alzheimer disease Neurology, September 28, 2004; 63(6): 975 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Murman, S. B. Kuo, M. C. Powell, and C. C. Colenda The impact of parkinsonism on costs of care in patients with AD and dementia with Lewy bodies Neurology, October 14, 2003; 61(7): 944 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Knopman, B. F. Boeve, and R. C. Petersen Essentials of the Proper Diagnoses of Mild Cognitive Impairment, Dementia, and Major Subtypes of Dementia Mayo Clin. Proc., October 1, 2003; 78(10): 1290 - 1308. [Abstract] [PDF]
|
|
|
|
|
|
A. R. Merdes, L. A. Hansen, D. V. Jeste, D. Galasko, C. R. Hofstetter, G. J. Ho, L. J. Thal, and J. Corey-Bloom Influence of Alzheimer pathology on clinical diagnostic accuracy in dementia with Lewy bodies Neurology, May 27, 2003; 60(10): 1586 - 1590. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Tiraboschi, L. A. Hansen, M. Alford, A. Merdes, E. Masliah, L. J. Thal, and J. Corey-Bloom Early and Widespread Cholinergic Losses Differentiate Dementia With Lewy Bodies From Alzheimer Disease Arch Gen Psychiatry, October 1, 2002; 59(10): 946 - 951. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Walker, D. G. Medicine, and T. Stevens Dementia with Lewy Bodies: Clinical Characteristics and Diagnostic Criteria J Geriatr Psychiatry Neurol, January 1, 2002; 15(4): 188 - 194. [Abstract] [PDF]
|
|
|
|
|
|
S. Minoshima, N. L. Foster, E. C. Petrie, R. L. Albin, K. A. Frey, and D. E. Kuhl Neuroimaging in Dementia with Lewy Bodies: Metabolism, Neurochemistry, and Morphology J Geriatr Psychiatry Neurol, January 1, 2002; 15(4): 200 - 209. [Abstract] [PDF]
|
|
|
|
|
|
M Yoshita, J Taki, and M Yamada A clinical role for [123I]MIBG myocardial scintigraphy in the distinction between dementia of the Alzheimer's-type and dementia with Lewy bodies J. Neurol. Neurosurg. Psychiatry, November 1, 2001; 71(5): 583 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mungas, B. R. Reed, W. G. Ellis, and W. J. Jagust The Effects of Age on Rate of Progression of Alzheimer Disease and Dementia With Associated Cerebrovascular Disease Arch Neurol, August 1, 2001; 58(8): 1243 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Stern, D. Jacobs, J. Goldman, E. Gomez-Tortosa, B. T. Hyman, Y. Liu, J. Troncoso, K. Marder, M. X. Tang, J. Brandt, et al. An Investigation of Clinical Correlates of Lewy Bodies in Autopsy-Proven Alzheimer Disease Arch Neurol, March 1, 2001; 58(3): 460 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. S. Hu, N. Okamura, H. Arai, M. Higuchi, T. Matsui, M. Tashiro, M. Shinkawa, M. Itoh, T. Ido, and H. Sasaki 18F-fluorodopa PET study of striatal dopamine uptake in the diagnosis of dementia with Lewy bodies Neurology, November 28, 2000; 55(10): 1575 - 1577. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Simard, R. van Reekum, and T. Cohen A Review of the Cognitive and Behavioral Symptoms in Dementia With Lewy Bodies J Neuropsychiatry Clin Neurosci, November 1, 2000; 12(4): 425 - 450. [Abstract] [Full Text]
|
|
|
|
|
|
W. C. Groves, J. Brandt, M. Steinberg, A. Warren, A. Rosenblatt, A. Baker, and C. G. Lyketsos Vascular Dementia and Alzheimer's Disease: Is There a Difference?: A Comparison of Symptoms by Disease Duration J Neuropsychiatry Clin Neurosci, August 1, 2000; 12(3): 305 - 315. [Abstract] [Full Text]
|
|
|
|
|
|
U. Hohl, P. Tiraboschi, L. A. Hansen, L. J. Thal, and J. Corey-Bloom Diagnostic Accuracy of Dementia With Lewy Bodies Arch Neurol, March 1, 2000; 57(3): 347 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. N. Sabbagh, J. Corey-Bloom, P. Tiraboschi, R. Thomas, E. Masliah, and L. J. Thal Neurochemical Markers Do Not Correlate With Cognitive Decline in the Lewy Body Variant of Alzheimer Disease Arch Neurol, December 1, 1999; 56(12): 1458 - 1461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Verghese, H. A. Crystal, D. W. Dickson, and R. B. Lipton Validity of clinical criteria for the diagnosis of dementia with Lewy bodies Neurology, December 1, 1999; 53(9): 1974 - 1974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Heyman, G. G. Fillenbaum, M. Gearing, S. S. Mirra, K. A. Welsh-Bohmer, B. Peterson, and C. Pieper Comparison of Lewy body variant of Alzheimer's disease with pure Alzheimer's disease: Consortium to Establish a Registry for Alzheimer's Disease, Part XIX Neurology, June 1, 1999; 52(9): 1839 - 1839. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Litvan and A. McKee Clinicopathologic Case Report J Neuropsychiatry Clin Neurosci, February 1, 1999; 11(1): 107 - 112. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
