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 Cognitive decline similar in DLB and AD 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Cognitive decline similar in DLB and AD
This is an interesting study of 58 DLB (Dementia with Lewy Bodies) subjects and 100 AD (Alzheimer's Disease) subjects, followed over a one-year period at 40 European centers. All patients had mild-moderate dementia. The diagnosis required a 123I-FP-CIT (dopamine transporter) SPECT. (There was no autopsy confirmation of the diagnoses.)

The authors state that DLB is associated with "earlier institutionalisation and a higher level of carer distress than are seen in Alzheimer's disease."

The authors believe prognosis info is important information for caregivers:

"Awareness of the rate of cognitive decline and also of non-cognitive symptoms can help carers and patients to adjust and plan appropriate lifestyle changes and to make arrangements for the future. This frequently involves making difficult decisions regarding treatment of psychiatric and motor symptoms and utilisation of limited resources available for patients with dementia."

The authors want to investigate why the prognosis in DLB is worse than in AD. They thought perhaps it was due to a faster cognitive decline in DLB as compared to AD. In fact, they found that there were no significant differences when comparing the rates of decline of cognitive and neuropsychiatric symptoms in DLB and AD. One of the key messages of the article is: "the worse prognosis of DLB is likely to be mediated by neuropsychiatric or other symptoms and not only by cognitive decline."

If interested, the full article is available online at no charge. See:
bmjopen.bmj.com.laneproxy.stanford.edu/content/2/1/e000380.full

I've copied the abstract below.

Robin



Here's the abstract:

BMJ Open. 2012 Feb 8.

Comparison of cognitive decline between dementia with Lewy bodies and Alzheimer's disease: a cohort study.

Walker Z, McKeith I, Rodda J, Qassem T, Tatsch K, Booij J, Darcourt J, O'Brien J.
Research Department of Mental Health Sciences, University College London, Bloomsbury Campus, London, UK.

Abstract

OBJECTIVES:
Dementia with Lewy bodies (DLB) accounts for 10%-15% of dementia cases at autopsy and has distinct clinical features associated with earlier institutionalisation and a higher level of carer distress than are seen in Alzheimer's disease (AD). At present, there is on-going debate as to whether DLB is associated with a more rapid cognitive decline than AD. An understanding of the rate of decline of cognitive and non-cognitive symptoms in DLB may help patients and carers to plan for the future.

DESIGN:
In this cohort study, the authors compared 100 AD and 58 DLB subjects at baseline and at 12-month follow-up on cognitive and neuropsychiatric measures.

SETTING:
Patients were recruited from 40 European centres.

PARTICIPANTS:
Subjects with mild-moderate dementia. Diagnosis of DLB or AD required agreement between consensus panel clinical diagnosis and visual rating of 123I-FP-CIT (dopamine transporter) single photon emission computed tomography neuroimaging.

OUTCOME MEASURES:
The Cambridge Cognitive Examination including Mini-Mental State Examination and Neuropsychiatric Inventory (NPI).

RESULTS:
The AD and DLB groups did not differ at baseline in terms of age, gender, Clinical Dementia Rating score and use of cholinesterase inhibitors or memantine. NPI and NPI carer distress scores were statistically significantly higher for DLB subjects at baseline and at follow-up, and there were no differences between AD and DLB in cognitive scores at baseline or at follow-up. There was no significant difference in rate of progression of any of the variables analysed.

CONCLUSIONS:
DLB subjects had more neuropsychiatric features at baseline and at follow-up than AD, but the authors did not find any statistically significant difference in rate of progression between the mild-moderate AD and DLB groups on cognitive or neuropsychiatric measures over a 12-month follow-up period.

PubMed ID#: 22318660 (see pubmed.gov for this abstract only)


Sat Feb 11, 2012 1:37 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Cognitive decline similar in DLB and AD
It comes as no surprise to me, as my husband certainly exhibited more neuropsychiatric symptoms than cognitive decline early on. And even now.

_________________
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.


Sat Feb 11, 2012 1:51 am
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Joined: Tue Aug 30, 2011 1:42 pm
Posts: 108
Post Re: Cognitive decline similar in DLB and AD
Interesting. Thank you Robin for sharing. This also fits with my experiences with my mother. She has almost certainly had neurological problems her whole life. She had a psychotic break in her 20s. I also think that there seems to be a lot more anxiety with DLB than with AD patients. I don't know if that is quantifiable, it may just be my own personal observations. What I have found interesting, and if I were to look for something positive (and it is a real iffy positive) that we are getting out of this experience, it would be that I understand better now how the world appears and has always appeared to my mother. She is not able to cover up for her paranoia and anger like she did when she was not having DLB symptoms. She seems to have multiple personalities - almost. I am so sad about what a terrifying place the world is for her, but it helps me understand things that seemed random and irrational in my own childhood. It also helps me feel more compassion for the things that happened when I was a child because I now understand that the world is a very different place for her than it is for me.

Liz


Sat Feb 11, 2012 8:39 pm
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Joined: Fri Nov 05, 2010 11:30 pm
Posts: 317
Location: southern cali
Post Re: Cognitive decline similar in DLB and AD
thanks robin..

liz i agree.. it amazing what my husband was holding in and not allowing himself to feel.. especially with post traumatic stress with vietnam.. he has never talked about it.. he stuffed it ALL down , so he never was able to show any emotions, at all.. now that he cant contain his thoughts, vietnam is all he talks about, the paranoia is very apparent, the anger is always just below the surface.. a lot of this is very scary, especially when he has hallucinations..

but there is good tho'.... he now can laugh and be silly... something he never allowed himself before..

cindi

_________________
sole CG for hubby.1st symptoms, 2000, at 55. Diag with AD at 62, LB at 64.. vietnam vet..100% ptsd disability,sprayed with agent orange, which doubled chances for dementia. ER visit 11-13,released to memory care..


Sun Feb 12, 2012 12:36 pm
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