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Clinical Signs of Lewy Body Dementia Consistent With Autopsy Findings: Presented at ANA By Paula Moyer SAN DIEGO, CA -- September 29, 2005 -- Patients with dementia who show the hallmark signs of the Lewy body subtype often have confirmatory autopsies, according to research presented here September 26th at the 130th annual meeting of the American Neurological Association (ANA). Debbie W. Tsuang, MD, Associate Professor of Psychiatry and Adjunct Associate Professor of Epidemiology, University of Washington, Seattle, Washington, United States, presented the findings The symptoms of Lewy body involvement typically include a parkinsonian-type gait and bradykinesia, as well as visual hallucinations. Patients with this condition have a higher risk of adverse effects from first-generation antipsychotics, and yet are more likely to respond quickly to cholinesterase inhibitors, Dr. Tsuang said. Therefore, patients with these symptoms should be treated empirically, using the assumption that their dementia has Lewy body involvement, Dr. Tsuang said in an interview. "It's important to try to differentiate this group based on [symptoms] as well as eventual pathophysiology," she said. The earlier patients are diagnosed, the earlier they can receive appropriate therapy, she said. Lewy body pathology is a common neuropathologic finding in patients with clinical Alzheimers disease, Dr. Tsuang said. However, the clinical diagnostic criteria for dementia with Lewy body lack consistent validity and applicability, she added, and noted that the sensitivity for the criteria ranges from 0% to 83% for probable Lewy body involvement, and the specificity ranges from 95% to 100%. The investigative team conducted prospective assessments on 258 patients in a large health maintenance organization in Seattle. When the patients died, the team compared autopsy findings to the clinical findings when the patients were alive. Of the 258 patients assessed prospectively, 152 had an initial clinical diagnosis of probable Alzheimer's disease and were included in the analysis. In addition to standard gross analyses, the investigators conducted alpha-synuclein immunostaining to fully characterize the presence of Lewy bodies. Results showed that 80 cases had Lewy body involvement and 72 cases did not. When the investigators conducted a statistical analysis, they found that women and patients with lower level of education, as well as those who were married at the time of diagnosis were at higher risk of having Lewy body dementia. In addition, those with bradykinesia and hallucinations, and those who had no symptoms of irritability, were more likely to have Lewy body involvement. The findings confirmed earlier research, Dr. Tsuang said. "It was very reassuring to find that parkinsonian symptoms -- bradykinesia, postural problems and shuffling gait, plus hallucinations -- were predictive toward having Lewy body pathology at autopsy," she said. [Presentation title: Accuracy of Predicting Lewy Body Disease Based on Clinical Presentation in Autopsied Subjects with Clinical Alzheimers Disease. Abstract 46] E-mail this page to a friend or colleague! To print, use this version