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 Better MMSE scores in DLB than AD or AD+DLB 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Better MMSE scores in DLB than AD or AD+DLB
Here's another paper published with the same National Alzheimer's Coordinating Center registry data that was used for another recent paper in the Journal of Neurology (published 10/1/09, PubMed ID#19795154) that I recently posted about.

In this paper, researchers compared "quantitatively the severity of cognitive impairment associated with DLB pathology vs Alzheimer disease (AD) and AD+DLB pathologies." "Mini-Mental State Examination (MMSE) scores showed that persons with pure DLB had cognitive impairment of relatively moderate severity (final MMSE score 15.6 +/- 8.7) compared to patients with pure AD and AD+DLB (final MMSE score 10.7 +/- 8.6 and 10.6 +/- 8.6)." [The higher the score, the better someone did on the test.]

Robin




Neurology. 2009 Oct 6;73(14):1127-33.

Relative preservation of MMSE scores in autopsy-proven dementia with Lewy bodies.

Nelson PT, Kryscio RJ, Jicha GA, Abner EL, Schmitt FA, Xu LO, Cooper G, Smith CD, Markesbery WR.
Department of Pathology, Division of Neuropathology, University of Kentucky Medical Center, Lexington, KY.

BACKGROUND: Recent studies raised questions about the severity of cognitive impairment associated with dementia with Lewy bodies (DLB). However, there have been few analyses of large, multicenter data registries for clinical-pathologic correlation.

METHODS: We evaluated data from the National Alzheimer's Coordinating Center registry (n = 5,813 cases meeting initial inclusion criteria) and the University of Kentucky Alzheimer's Disease Center autopsy series (n = 527) to compare quantitatively the severity of cognitive impairment associated with DLB pathology vs Alzheimer disease (AD) and AD+DLB pathologies.

RESULTS: Mini-Mental State Examination (MMSE) scores showed that persons with pure DLB had cognitive impairment of relatively moderate severity (final MMSE score 15.6 +/- 8.7) compared to patients with pure AD and AD+DLB (final MMSE score 10.7 +/- 8.6 and 10.6 +/- 8.6). Persons with pure DLB pathology from both data sets had more years of formal education and were more likely to be male. Differences in final MMSE scores were significant (p < 0.01) between pure DLB and both AD+DLB and pure AD even after correction for education level, gender, and MMSE-death interval. Even in cases with extensive neocortical LBs, the degree of cognitive impairment was most strongly related to the amount of concomitant AD-type neurofibrillary pathology.

CONCLUSIONS: Dementia with Lewy bodies can constitute a debilitating disease with associated psychiatric, motoric, and autonomic dysfunction. However, neocortical Lewy bodies are not a substrate for severe global cognitive impairment as assessed by the Mini-Mental State Examination. Instead, neocortical Lewy bodies appear to constitute or reflect an additive disease process, requiring Alzheimer disease or other concomitant brain diseases to induce severe global cognitive deterioration.

PubMed ID#: 19805729


Thu Oct 08, 2009 11:52 pm
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Joined: Wed Feb 25, 2009 5:28 am
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Location: New Hampshire/Somerset UK
Post on the other hand...
I'm not sure there's anything here we don't know already. And maybe you have posted this when it was first e-pubbed.... cheers and hugs to you all, Franks2ndaughter

Arch Gerontol Geriatr. 2009 Sep-Oct;49(2):e101-4. Epub 2008 Dec 11.
Clinical findings, functional abilities and caregiver distress in the early stage of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD).

Ricci M, Guidoni SV, Sepe-Monti M, Bomboi G, Antonini G, Blundo C, Giubilei F.
Regina Apostolorum Hospital, Albano Laziale, Italy.
Few studies have compared neuropsychiatric disorders and functional abilities in the early stage of DLB and AD and their influence on caregiver distress. The aim of this study is to assess neuropsychiatric disorders, functional abilities and caregiver distress in DLB and in AD subjects. Sixteen subjects affected by probable DLB and 12 subjects affected by probable AD were enrolled. All subjects underwent a wide neuropsychological examination. Caregiver's distress was also assessed. Subjects affected by DLB performed better in long-term memory tests, whereas AD subjects performed better in attentive and executive function tests. The Neuropsychiatric Inventory (NPI) total score was significantly higher in DLB subjects than in AD subjects. Furthermore, DLB subjects scored worse than AD subjects in both Activities of Daily Living scale (ADL) and Instrumental Activities of Daily Living scale (IADL) scales. Overall caregiver distress was higher in DLB than in AD subjects. High distress was observed in DLB caregivers alone and was caused by delusion, hallucinations, anxiety and apathy. DLB subjects have a different neuropsychological profile, more psychiatric symptoms and more serious functional deficits than AD subjects in the early cognitive decline, furthermore DLB caregivers are more stressed than AD caregivers.
PMID: 19084284


Sat Oct 17, 2009 5:56 am
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Joined: Wed Feb 25, 2009 5:28 am
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Location: New Hampshire/Somerset UK
Post A different new comparison of LBD and AD
This one is from the Int J Geriatr Psychiatry. 2009 Feb;24(2):125-31. "The neuropsychological profile in dementia with Lewy bodies and Alzheimer's disease." I wonder if this test would have differentiated my Dad as Not having LBD, despite all symptoms to the contrary... hugs to you all,
Franks2ndaughter
-------------
Oda H, Yamamoto Y, Maeda K. The Division of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.

OBJECTIVE: To demonstrate the exact nature of the cognitive profile of dementia with Lewy bodies (DLB) on standardized neuropsychological tests including the Wechsler Adult Intelligence Scale--Revised (WAIS-R) and the Wechsler Memory Scale--Revised (WMS-R). DESIGN: We examined the WAIS-R and the WMS-R of 26 patients with probable DLB (based on the Consensus Criteria for the clinical diagnosis of DLB) and of 78 patients with probable Alzheimer's disease (AD) (based on criteria of the National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's disease and Related Disorders Association) who were matched to the patients with DLB 3:1 by Mini-Mental State Examination score. RESULTS: The DLB group scored significantly lower on the Block Design, Object Assembly and Digit Symbol of WAIS-R and significantly higher on the Logical Memory I, Verbal Paired Associates I, Logical Memory II, Visual Paired Associates II, Verbal Paired Associates II and Visual Reproduction II of WMS-R (p < 0.0016 to p < 0.0001). In a comparison between the DLB group and the AD group, a logistic regression analysis revealed that the weighted sum score of the Object Assembly and the Logical Memory II may differentiate DLB from AD with a sensitivity of 0.81 [95% Confidence Intervals (CI) = 0.66-0.96] and a specificity of 0.76 (95% CI = 0.66-0.85). CONCLUSIONS: The WAIS-R and the WMS-R can help to differentiate DLB from AD. (c) 2008 John Wiley & Sons, Ltd. PMID: 18615776


Tue Nov 03, 2009 9:45 am
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Post 
Celia,
Have you sat down with the neurologists/psychiatrists who mis-diagnosed your father? Would his treatment have been any different?
Robin


Tue Nov 03, 2009 11:39 am
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Post misdiagnosis -- well, uh...
Hi, Robin, Things are geographically too complicated to do that, and once someone is dead, or even alive but being treated "elsewhere", doctors just can't be bothered with you. Even if they did sit down with us, I'm sure they wouldn't say they misdiagnosed him -- they never said conclusively what he had. The entertained the possibility. That was the people in Michigan. They are the ones that, as far as I know, have never sent my Dad's medical records to the lab in FL where they did the brain autopsy. At the intensive care and pulmonary units in NH, where the diagnosis was critical for appropriate anti-psychotic medication, they couldn't be bothered to find a geriatric psychiatrist who knew about LBD to try to diagnose my father correctly. He moved from the ICU to pulmonary care to a rehab hospital and back to pulmonary, where he died.

I have too much else on my plate at this point to look back. If I thought I would be helping anyone to be a better doctor, I might stomp my feet and make some noise, but the science isn't there yet, the staff who would, could care aren't there, and none of them -- not the hospital staff in NH, nor my father's docs in MI who did the extensive neuropsychiatric and MRI testing, nor the researchers in FL who did the autopsy have enough of the data to put the picture together -- or even care enough to help one of the other parties to do so. Meanwhile, I'm in the UK and it all feels way too far away.


Tue Nov 03, 2009 12:35 pm
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Location: SF Bay Area (Northern CA)
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Hi Celia,

Sorry to hear that the MDs in Michigan are so uncooperative. Most (all?) of the neurologists here in the SF Bay Area will sit down with the family after receiving the neuropathology report and review the report and the clinical records with the family. It's really a wonderful service they offer.

How would an accurate diagnosis of your father's condition affected the administration of anti-psychotics?

Robin


Tue Nov 03, 2009 12:40 pm
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Hi, Robin,
I'm not sure. LBD is much more sensitive to some of the antipsychotics, but it may be that they just know more about that than about the response of other dementias, psychosis, sleep disturbance, etc when caused by AD and things other than LBD, as in my Dad's case. Some of the anti-psychotics that were used on my dad do have warning messages about long-term use more generally in dementia.

My perception -- based on what my sisters were telling me over the phone and what I garnered the two times I spoke with the docs in NH -- is that they were basically throwing any meds at my Dad that they could think of, without bothering to think about interactions or observe or consider longer range effects. "We don't know what he's got but he's a behavioral nuisance and he's old so let's try this." The first time my Dad got this random pharmacopia treatment was in yet another hospital and it threw him into the loonies for more than two months.

It took getting him out of the hospital and intensive personal care from my sisters, home nurses, and me to get him back to semi-reasonable functioning (non-delusional and mostly sleeping at night and being awake during the day.) So I guess really, accurate diagnosis and effective, evidence-based medication plans would have done as much for me as for him -- better treatment for him, and peace of mind and confidence in his treatment for me/us. As it is, I think his being in the hospital contributed as much to his death as it did to saving his life. Gosh! I didn't realize quite how much anger I still have about all this.


Tue Nov 03, 2009 1:07 pm
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