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Influence of Alzheimer pathology on clinical diagnostic accuracy in dementia with Lewy bodies

A R Merdes1, L A Hansen, D V Jeste

  • 1Department of Neurosciences, University of California, San Diego 92161, USA.

Neurology
|May 29, 2003
PubMed
Abstract

Insights

The severity of Alzheimer's disease (AD) tangle pathology impacts the clinical diagnosis of dementia with Lewy bodies (DLB). Higher tangle pathology in DLB patients reduces diagnostic accuracy, highlighting the need to consider co-existing pathologies.

Area of Science:

  • Neurology
  • Pathology
  • Geriatrics

Background:

  • Dementia with Lewy bodies (DLB) diagnosis requires Lewy bodies but often co-occurs with Alzheimer's disease (AD) pathology.
  • Clinical diagnostic accuracy for DLB is challenging.
  • The influence of AD neurofibrillary pathology on DLB diagnosis is unclear.

Purpose of the Study:

  • To investigate if Alzheimer's disease (AD) neurofibrillary tangle pathology affects the clinical diagnostic accuracy of dementia with Lewy bodies (DLB).

Main Methods:

  • Analyzed 98 autopsy-proven DLB cases evaluated at UCSD AD Research Center.
  • Assessed neurofibrillary tangle pathology using Braak staging.
  • Compared clinical features and diagnostic accuracy between DLB subjects with low vs. high Braak stages.

Main Results:

  • Only 27% of DLB subjects presented with both visual hallucinations and extrapyramidal signs (EPS).
  • Higher visual hallucination frequency observed in DLB with low Braak stages (65%) vs. high Braak stages (33%).
  • Clinical diagnostic accuracy for DLB was significantly higher in low Braak stage cases (75%) compared to high Braak stage cases (39%).

Conclusions:

  • Concomitant Alzheimer's disease (AD) tangle pathology significantly influences the clinical presentation of dementia with Lewy bodies (DLB).
  • The degree of AD tangle pathology directly impacts the accuracy of clinical DLB diagnosis.
  • Considering co-existing AD pathology is crucial for improving DLB diagnostic accuracy.

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