Lewy Body Versus Alzheimer's Dementias and Parkinson's

One clinical challenge is making an accurate diagnosis in patients with dementia.

Alzheimer's disease is typically the predominant diagnosis in dementia. However a significant number of patients will present with dementia due to Lewy Body disease, Parkinson's dementia,  frontotemporal dementia or vascular dementia.

A recent study helps clinicians to distinguish Lewy Body  from Alzheimer's dementia and Parkinson's disease.

Douglas Scharre and collegues from Ohio State University conducted a matched pair analysis of 21 patients with Lewy Body dementia with 21 patients with Alzheimer's disease and 21 patients with Parkinson's disease.

Parkinson's disease subjects in this study had higher cognitive function scores than the Lewy Body disease subjects but were matched on level of motor impairment.

Subject groups were assessed on a variety of motor, cognitive and neuropsychological domains. Lewy Body dementia subjects differed from the Alzheimer's group in the following areas:

• Higher impairment scores on executive function and visuospatial function
• Lower impairment on memory and orientation
• Higher scores on measures of sleepiness
• Higher scores on fluctuation of cognitive and behavior deficits
• More hallucinations
• More sleep apnea

Lewy body dementia subjects differed from the Parkinson's disease group in the following areas:

• More impairment in axial motor function
• More impairment in gait and balance function
• Higher scores on measures of sleepiness
• Higher scores on fluctuation of cognitive and behavior deficits
• More hallucinations
• More sleep apnea

The authors noted that measures of axial motor, gait and balance impairment correlated higher with level of executive function impairment, visuomotor function impairment and global cognitive impairment.

This is an important study and highlights the need for specific neuropsychological testing along with assessment of motor, gait and balance domains dementia evaluations.

Readers with more interest in this study can access the author's uncorrected proofs by clicking on the DOI link in the citation below.

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Scharre, D., Chang, S., Nagaraja, H., Park, A., Adeli, A., Agrawal, P., Kloos, A., Kegelmeyer, D., Linder, S., Fritz, N., Kostyk, S., & Kataki, M. (2016). Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases Journal of Alzheimer's Disease, 1-10 DOI: 10.3233/JAD-160384

Alzheimer's Disease Behavioral Checklist: Link

Yesterday I posted on a research effort to develop a more behavioral-based screening process for early detection of Alzheimers and other dementia.

You can access that post by clicking HERE.

Since I posted that I have come across a proposed 34 item screening scale. The link to that scale is HERE.

This is not validated scale for clinical use but is in the development stage. I wanted readers who were interested in this research to have access to a PDF copy of the scale.

Follow the author on Twitter HERE (WRY999)

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Behavioral Warnings in Early Alzheimer's Disease

There are some interesting research updates coming out of the Alzheimer's Association International Conference in Toronto.

One finding that caught my eye was a report on behavioral changes that might precede significant cognitive impairment in Alzheimer's and other dementia.

This is being labelled "mild behavioral impairment" and like mild cognitive impairment may precede the clinical presentation of a dementia.

The Alzheimer's Association has put together a committee to formalize these criteria. The behavioral changes must be not characteristic of the individual and be present for at least six months.

The slide accompanying this post lists some of the behavioral warning signs being considered for "mild cognitive impairment".

Read about this effort in the Medical Xpress story HERE.

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Delirium and Aortic Valve Surgery Outcome

Delirium is an acute confusional state that is common in elderly hospitalized patients.

I think of it light a sign of acute brain failure requiring aggressive attentional for detection and treatment of any reversible underlying causes.

Delirium in elderly hospitalized patients is a marker for poor outcome in a variety of medical and surgical subjects.

A recent study published by a Norwegian team found effects on outcome for delirium following surgical aortic valve replacement. The key findings from the study included:

• An lower rate of delirium for subjects receiving catheter valve replacement than surgical replacement
• Lower physical outcome scores at 6 months for those experiencing post-op delirium
• Longer term outcomes between those with delirium and those without delirium were not different

The study supports monitoring for delirium during the period after aortic valve surgery. Delirium may indicate a need for more intensive rehabilitation in the short-term recovery period.

The free full text manuscript can be accessed here.

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Eide LS, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KK, Nordrehaug JE, Norekvål TM, & Delirium in Octogenarians Undergoing Cardiac Surgery or Intervention-CARDELIR Investigators (2016). Delirium as a Predictor of Physical and Cognitive Function in Individuals Aged 80 and Older After Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement. Journal of the American Geriatrics Society PMID: 27106745