Frequency and Case Identification of Dementia with Lewy Bodies Using the Revised Consensus Criteria

Objective: To find the proportion of dementia with Lewy bodies (DLB) in a referral cohort of patients with a first-time diagnosis of mild dementia. Background: The proportion of DLB among the dementia sufferers is not known and the clinical consensus criteria have low sensitivity. We employed the revised DLB criteria to study the proportion with DLB in a community sample of patients with mild dementia. Methods: From March 2005 to March 2007, we included 196 patients from referrals to all geriatric medicine, old age psychiatry and neurology outpatient clinics in Rogaland and Hordaland counties in Western Norway. Standardized clinical instruments and diagnostic criteria were employed. Results: 65% had Alzheimer dementia, 20% DLB (16% probable DLB), 5.6% vascular dementia, 5.6% Parkinson disease with dementia, 2.0% frontotemporal dementia and 1.5% alcoholic dementia. There were no significant differences in the proportion with DLB according to age bands and dementia severity groups. The revised criteria for a clinical diagnosis of DLB increased the proportion of probable DLB by 25% compared to the previous criteria. Conclusion: DLB is common in patients with mild dementia, and is the second most common type of dementia. The introduction of new clinical criteria for DLB leads to an increase in the proportion diagnosed with probable DLB.

[1]  E. Londos,et al.  Contributions of Other Brain Pathologies in Dementia with Lewy Bodies , 2002, Dementia and Geriatric Cognitive Disorders.

[2]  I Litvan,et al.  Accuracy of four clinical diagnostic criteria for the diagnosis of neurodegenerative dementias , 1999, Neurology.

[3]  I G McKeith,et al.  The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale. Two methods to assess fluctuating confusion in dementia. , 2000, The British journal of psychiatry : the journal of mental science.

[4]  E. Moriguchi,et al.  Prevalence of dementia in the older Japanese‐Brazilian population , 2002, Psychiatry and clinical neurosciences.

[5]  S. Fahn.  Unified Parkinson's Disease Rating Scale , 1987 .

[6]  S Minoshima,et al.  Diagnosis and management of dementia with Lewy bodies , 2005, Neurology.

[7]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[8]  M. Onofrj,et al.  Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium , 2006, Neurology.

[9]  C. Miller,et al.  Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians , 2004, American journal of Alzheimer's disease and other dementias.

[10]  I. McKeith,et al.  More severe functional impairment in dementia with lewy bodies than Alzheimer disease is related to extrapyramidal motor dysfunction. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[11]  G. Livingston,et al.  Islington study of dementia subtypes in the community. , 2002, The British journal of psychiatry : the journal of mental science.

[12]  E. Londos,et al.  Patients with Lewy body dementia use more resources than those with Alzheimer's disease , 2007, International journal of geriatric psychiatry.

[13]  K. Jellinger,et al.  Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. , 1996, Neurology.

[14]  C. Brayne,et al.  A systematic review of prevalence and incidence studies of dementia with Lewy bodies. , 2005, Age and ageing.

[15]  Linas A. Bieliauskas,et al.  Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test , 2005, The Clinical neuropsychologist.

[16]  V Hachinski,et al.  The effect of different diagnostic criteria on the prevalence of dementia. , 1997, The New England journal of medicine.

[17]  Dag Aarsland,et al.  Neuroleptic sensitivity in Parkinson's disease and parkinsonian dementias. , 2005, The Journal of clinical psychiatry.

[18]  D. Dickson,et al.  IN DEMENTIA WITH LEWY BODIES, BRAAK STAGE DETERMINES PHENOTYPE, NOT LEWY BODY DISTRIBUTION , 2007, Neurology.

[19]  M. Mega,et al.  The Neuropsychiatric Inventory , 1994, Neurology.

[20]  I. McKeith,et al.  Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study , 2007, The Lancet Neurology.

[21]  K. Heilman,et al.  Relative Frequencies of Alzheimer Disease, Lewy Body, Vascular and Frontotemporal Dementia, and Hippocampal Sclerosis in the State of Florida Brain Bank , 2002, Alzheimer disease and associated disorders.

[22]  J. Fogarty,et al.  Boston Naming Test Short Forms: A Comparison of Previous Forms with New Item Response Theory Based Forms , 2004, Journal of clinical and experimental neuropsychology.

[23]  J. Morris,et al.  Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease , 2006, Neurology.

[24]  L. Thal,et al.  What best differentiates Lewy body from Alzheimer's disease in early-stage dementia? , 2006, Brain : a journal of neurology.

[25]  J Marshall,et al.  Cerebral blood flow in dementia. , 1975, Archives of neurology.

[26]  A. Swann,et al.  Prospective validation of Consensus criteria for the diagnosis of dementia with Lewy bodies , 2000, Neurology.

[27]  R. Sulkava,et al.  Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older , 2003, Journal of neurology, neurosurgery, and psychiatry.

[28]  Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[29]  D. Dickson,et al.  IN DEMENTIA WITH LEWY BODIES, BRAAK STAGE DETERMINES PHENOTYPE, NOT LEWY BODY DISTRIBUTION. Authors' reply , 2008 .

[30]  K. Jellinger,et al.  The enigma of vascular cognitive disorder and vascular dementia , 2007, Acta Neuropathologica.

[31]  D W Dickson,et al.  DLB fluctuations , 2004, Neurology.

[32]  M. D. O'Brien,et al.  Cerebral blood flow in dementia , 1986, Neurology.

[33]  G. C. Román,et al.  Vascular dementia , 1993, Neurology.

[34]  E. Londos,et al.  Patients with dementia with lewy bodies have more impaired quality of life than patients with Alzheimer disease. , 2007, Alzheimer disease and associated disorders.

[35]  Anthony F Jorm,et al.  The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms , 1989, Psychological Medicine.

[36]  J Taki,et al.  Value of 123I-MIBG radioactivity in the differential diagnosis of DLB from AD , 2006, Neurology.

[37]  B S Linn,et al.  The Rapid Disability Rating Scale—2 , 1982, Journal of the American Geriatrics Society.

[38]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[39]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[40]  E. Tolosa,et al.  Clinical diagnostic criteria for dementia associated with Parkinson's disease , 2007, Movement disorders : official journal of the Movement Disorder Society.

[41]  J. Morris,et al.  Clinical Dementia Rating: A Reliable and Valid Diagnostic and Staging Measure for Dementia of the Alzheimer Type , 1997, International Psychogeriatrics.