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 4 things that may distinguish DLB from other dementias 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post 4 things that may distinguish DLB from other dementias
This English-language abstract of a Chinese research article on DLB concludes as follows: "Early presence of hallucination, a high prevalence of sleep disorders, axial rigidity and hypometabolism of occipital lobe on PET may help to distinguish DLB from other types of dementia."
Robin



Zhonghua Yi Xue Za Zhi. 2011 Jun 21;91(23):1617-20.

[Clinical features and treatment of dementia with Lewy bodies].
[Article in Chinese]

Li L, Wang JT, Zhang ZX, Cui RX, Yuan J.
Department of Neurology, Peking Union Medical College Hospital, Beijing, China.

Abstract

OBJECTIVE:
To investigate the clinical, neuropsychological, neuroimaging features and treatment of dementia with Lewy bodies (DLB).

METHODS:
The clinical, neuropsychological, neuroimaging and therapeutic features of 33 DLB patients were retrospectively analyzed.

RESULTS:
There were 25 males and 8 females. The mean course from onset to diagnosis was 3.3 years. Sleep disorder, depression, anxiety and constipation were present at 1 - 10 years prior to DLB onset in 10 patients. Memory impairment (52%) and parkinsonism (21%) were initial symptoms. The mean duration from memory impairment to presence of parkinsonism was 17 months. Pattern of extrapyramidal signs showed bilateral, symmetry and axial muscles bias as postural instability and facial impassivity, tremor was less in DLB. Hallucination (70%), sleep disorder (63%), apathy (56%) and delusion (52%) were the major behavioral and psychological symptoms. Hallucination occurred within a mean of 15 months after presence of initial symptoms. Cognition impairment progressed rapidly in half of patients. Neuropsychological tests of mild patients revealed visuospatial dysfunction and relatively preservation of memory. Severe impairment of all domains of cognition was noticed in moderate-severe patients. MRI (magnetic resonance imaging) revealed the preservation of hippocampal structures. And PET (positron emission tomography) showed hypometabolism of occipital lobe. Cholinesterase inhibitors could improve cognitive impairment and behavioral symptoms in a large majority of patients.

CONCLUSION:
Neuronal dysfunction may be present at an early stage of DLB. Early presence of hallucination, a high prevalence of sleep disorders, axial rigidity and hypometabolism of occipital lobe on PET may help to distinguish DLB from other types of dementia.

PubMed ID#: 21914395 (see pubmed.gov for this English-language abstract)


Tue Sep 20, 2011 1:34 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: 4 things that may distinguish DLB from other dementias
Very interesting.

Can you tell -- were these post-mortem confirmed DLB cases?

Thanks for sharing.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Tue Sep 20, 2011 8:18 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: 4 things that may distinguish DLB from other dementias
I'm sure they weren't.


Tue Sep 20, 2011 11:33 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: 4 things that may distinguish DLB from other dementias
So the value of this study is ... ?

How can you identify 4 (or 9 or 1) things that distinguish DLB from other dementias when you aren't even sure you are looking at cases of DLB?

Sorry. I was strictly Liberal Art ... maybe the Science stuff is over my head.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Wed Sep 21, 2011 12:12 am
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Joined: Tue Mar 29, 2011 3:02 pm
Posts: 386
Location: East TN
Post Re: 4 things that may distinguish DLB from other dementias
Jeanne…..

let take a wild guess…

this is the Chinese…..

if you can pull out the DLB patients….

then break them out in sub groups….

which group has cognitive decline faster or slower….

which group has motor decline faster or slower….

manage those groups….or at least pick out the groups to manage…
you can keep those groups working or productive longer….

they are looking for productivity….
reduce time from onset to diagnosis…
subset productive groups from unproductive groups….
medicate…or ………………

I like 'some' of their thinking….maybe not for the same reasons….
this study has me written all over it….

they are attacking it from the front end….

science is about questions that you don't have the answer….until you do...

_________________
Craig - Patient - Male - 56 years old - Lewy Bodies diagnosed on March 23, 2011 - cognitive disorder NOS dx 2007 - RBD REM dx 2007 issues for 20+ years - intention tremor 1974 - other issues many years


Wed Sep 21, 2011 4:07 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: 4 things that may distinguish DLB from other dementias
Jeanne,
If we only looked at studies with autopsy-confirmation, there would be almost nothing to look at! To me, the main value of the study is that any Chinese members on the Forum know that there are some Chinese researchers looking into DLB.
Robin


Wed Sep 21, 2011 11:45 am
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Joined: Thu Apr 21, 2011 9:07 pm
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Post Re: 4 things that may distinguish DLB from other dementias
Hi Robin,
It is good to know that there is interest in DLB research in China, I agree! Though still not too much (quick superficial search of pubmed gave only 18 papers and the quality was mixed. There is a lot more on dementia in general and on AD.) Since I don't read Chinese, I can't be sure, but the abstract doesn't mention a non-DLB comparison group, so not clear how they'd draw any conclusions about DLB being different from something else.

There has been some discussion of possibly starting a Chinese partner study of the Alzheimer's Disease Neuroimaging Initiative, but so far as I know, it's still just talk at this point. And there was one very large well-done population-based study of dementia in Shanghai, and they reported prevalence of dementia and its subtypes. They reported patterns similar to Western countries (Annals of Neurol 1990; Arch Neurol 2005; and other papers) but almost all their work has focused on Alzheimer's and vascular dementia, not DLB. Of course all of this is clinical diagnosis, very little post-mortem confirmation.

Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD; died May, 2014.


Sat Sep 24, 2011 6:23 pm
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