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 Older people are less likely to have DLB+less severe DLB 
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Joined: Fri Aug 11, 2006 1:46 pm
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Post Older people are less likely to have DLB+less severe DLB
I learned from reading this study that if you have DLB or AD, the older you are the less severe the disease pathology is. I would've thought the facts were exactly opposite.

This UCSD study looks at the donated brains of Dementia with Lewy Bodies cases, Alzheimer's Disease cases, and normal controls in three age groups -- 70-79, 80-89, and 90 or older. The last group is called the "oldest old."

The full article contains info that *all* of the DLB cases actually had enough plaques to meet the criteria for probable AD. "However, all cases had a Braak stage less than 4, and were classified as DLB (“mixed-DLB”). Cases having a Braak stage of 5 or 6 and displaying unequivocal AD tangle pathology are classified as AD." We are told that these dementia cases did not have much vascular pathology.

Over 500 cases were studied -- "197 (38%) were between ages 70 and 79, 243 (48%) between ages 80 and 89, and 72 (14%) were 90 and above."

"Comparing youngest and oldest groups, the proportion of AD cases increased significantly with increasing age (69.5% as compared to 89%)."

"In contrast, proportion of DLB cases as a percentage of all cases (DLB and AD) decreased significantly with increasing age (27% as compared to 8%), while 64/398 (16%) of AD cases were above 90 years, only 6/98 (6%) DLB cases were above 90 years."

This seems to be the key statement of results: "These studies showed that frequency and severity of DLB was lower in 80-89 and >= 90 year cases compared to 70-79 year old group but cognitive impairment did not vary with age."

So, the older you are the LESS likely you are to have DLB (perhaps because DLB survival time is shorter) and the LESS severe your DLB (as measured by the extent of which Lewy bodies are diffuse throughout the brain). However, the older you are, you are NOT necessarily more impaired cognitively than a younger person.

Robin


Neuroscience Letters. 2010 Nov 26;485(3):222-7. Epub 2010 Sep 21.

Neuropathology of dementia with Lewy bodies in advanced age: a comparison with Alzheimer disease.

Ubhi K, Peng K, Lessig S, Estrella J, Adame A, Galasko D, Salmon DP, Hansen LA, Kawas CH, Masliah E.
Department of Neurosciences, University of California, San Diego, La Jolla, CA.

Abstract
Dementia with Lewy Bodies (DLB) is a common neurodegenerative disorder of the aging population characterized by a-synuclein accumulation in cortical and subcortical regions. Although neuropathology in advanced age has been investigated in dementias such as Alzheimer Disease (AD), severity of the neuropathology in the oldest old with DLB remains uncharacterized.

For this purpose we compared characteristics of DLB cases divided into three age groups 70-79, 80-89 and >= 90 years (oldest old). Neuropathological indicators and levels of synaptophysin were assessed and correlated with clinical measurements of cognition and dementia severity.

These studies showed that frequency and severity of DLB was lower in 80-89 and >= 90 year cases compared to 70-79 year old group but cognitive impairment did not vary with age.

The extent of AD neuropathology correlated with dementia severity only in the 70-79 year group, while synaptophysin immunoreactivity more strongly associated with dementia severity in the older age group in both DLB and AD.

Taken together these results suggest that the oldest old with DLB might represent a distinct group.

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

PMID: 20849919 (see pubmed.gov for this abstract only)


Wed Oct 27, 2010 2:05 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Older people are less likely to have DLB+less severe DLB
Quote:
perhaps because DLB survival time is shorter
Seems to me that is the key. How many with DLB would live into their mid-80's, much less their 90's?

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Oct 27, 2010 2:58 pm
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Joined: Wed Oct 28, 2009 11:53 am
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Location: Ocala, FL
Post Re: Older people are less likely to have DLB+less severe DLB
Dear Robin:

This is just a bit off subject but I'm hoping you'll respond. Dale (75) was diagnosed in Aug 09. He complained of dizziness for about 6 years. Then, in early 09, he had severe hallucinations at the end of January 09 which continued.

He has no tremor and does not need a walking aid. He has some difficulty rising from a chair and he sort of falls into a chair rather than sitting but his physical symptoms are minimal. He still works out in his home gym.

However, the delusions and hallucinations have recently become much more of a problem. He takes Sinemet 25/100 3 times a day and Seroquel 100 before bed. I think the Sinemet is causing problems rather than helping him but his neurologist argued with me and at first, she agreed to allow me to reduce the dose but then insisted that he be back on the full dose.

My question is, "What are the chances.... Will he become physically incapacitated without the Sinemet - or is that something we can predict?" I really hate the delusions and hallucinations (especially Capgras). He has never been violent or difficult. He is a mild mannered man.

_________________
Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Wed Oct 27, 2010 4:34 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Older people are less likely to have DLB+less severe DLB
Leone has re-posted her question to the "Treatment Options" area of the Forum here:
viewtopic.php?f=4&t=2557


Wed Oct 27, 2010 5:11 pm
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