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NEUROLOGY 2005;64:2069-2073
© 2005 American Academy of Neurology

Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both

M. L. Kraybill, BA, E. B. Larson, MD, D. W. Tsuang, MSc, MD, L. Teri, PhD, W. C. McCormick, MD, J. D. Bowen, MD, W. A. Kukull, PhD, J. B. Leverenz, MD and M. M. Cherrier, PhD

From the Mental Illness Research, Education, and Clinical Center (Drs. Tsuang, Leverenz, and Cherrier, M.L. Kraybill), Veterans Administration Puget Sound Health Care System, Seattle, and Departments of Medicine (Drs. Larson and McCormick), Psychiatry and Behavioral Sciences (Drs. Tsuang, Leverenz, and Cherrier), Psychosocial and Community Health (Dr. Teri), Neurology (Drs. Bowen and Leverenz), and Epidemiology (Dr. Kukull), University of Washington, Seattle.

Address correspondence and reprint requests to Dr Cherrier, S-116 MIRECC, VAPSHCS, 1660 S. Columbian Way, Seattle, WA 98108; e-mail: cherrier{at}u.washington.edu

Objective: To examine the neuropsychological profile of dementia patients from a community-based autopsy sample of dementia, comparing Alzheimer disease (AD), Lewy body pathology (LBP) alone, and LBP with coexistent AD (AD/LBP).

Methods: The authors reviewed 135 subjects from a community-based study of dementia for whom autopsy and brain tissue was available. Diagnostic groups were determined according to standard neuropathologic methods and criteria, and the presence of LBs was determined using {alpha}-synuclein immunostaining. Neuropathologically defined diagnostic groups of AD, AD/LBP, and LBP were examined for differences on neuropsychological test performance at the time of initial study enrollment.

Results: There were 48 patients with AD alone, 65 with LB and AD pathology (AD/LBP), and 22 with LBP alone (LBP alone). There were no significant differences between groups demographically or on performance of enrollment Mini-Mental State Examination (MMSE) or Dementia Rating Scale (DRS). AD patients performed worse than the LBP patients on memory measures (Fuld Object Memory Evaluation Delayed Recall, Wechsler Memory Scale Logical Memory Immediate and Delayed Recall; p < 0.05) and a naming task (Consortium to Establish a Registry for Alzheimer’s Disease Naming; p < 0.05). LBP patients were more impaired than AD patients on executive function (Trail Making Test Part B; p < 0.05) and attention tasks (Wechsler Adult Intelligence Scale–Revised Digit Span; p < 0.05). Decline in MMSE and DRS scores over time were greatest in the patients with AD/LBP.

Conclusions: In a community-based sample of older, medically complicated patients with dementia, there are neuropsychological differences between dementia subtypes at the time of diagnosis. In particular, patients with Alzheimer disease (AD) alone and AD/Lewy body pathology (LBP) had more severe memory impairment than patients with LBP. LBP alone was associated with more severe executive dysfunction. Patients with AD/LBP had the most rapid rate of cognitive decline.

The Alzheimer’s Disease Patient Registry was supported in part by a grant from the National Institute on Aging (UO1-AG06781).

Received September 6, 2004. Accepted in final form March 7, 2005.




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