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Brain Advance Access published online on January 9, 2006
Brain, doi:10.1093/brain/awh725
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received October 7, 2005
Revised November 18, 2005
Accepted November 25, 2005

Article

What best differentiates Lewy body from Alzheimer's disease in early-stage dementia?

Pietro Tiraboschi 1, David P. Salmon 2, Lawrence A. Hansen 2, Richard C. Hofstetter 2, Leon J. Thal 3, and Jody Corey-Bloom 3 *

1 Dipartimento di Scienze Neurologiche, Ospedale Niguarda Ca' Granda, Milano, Italy; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
2 Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
3 Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Neurology Service, VA San Diego Healthcare System, San Diego, CA, USA

* To whom correspondence should be addressed.
Jody Corey-Bloom, E-mail: jcoreybl{at}vapop.ucsd.edu


  Abstract

To determine which clinical feature(s) [among visual hallucinations (VH), extrapyramidal signs (EPS) and visuospatial impairment] in the earliest stages of disease best predicted a diagnosis of dementia with Lewy bodies (DLB) at autopsy, first-visit data of 23 pathologically proven DLB and 94 Alzheimer's disease cases were compared. There were no group differences with regard to age, gender, education or global severity of dementia at presentation (mean Mini-Mental State Examination: 24.0 versus 25.0, mean Dementia Rating Scale: 123.6 versus 125.7). DLB patients at initial presentation displayed an increased frequency of VH (P = 0.001), but not EPS (P = 0.3), compared to Alzheimer's disease patients. However, only a minority of DLB cases had either VH (22%), EPS (26%) or both (13%). In contrast, although not a core feature, visuospatial/constructional impairment was observed in most of the DLB cases (74%). Among clinical variables, presence/recent history of VH was the most specific to DLB (99%), and visuospatial impairment was the most sensitive (74%). As a result, VH at presentation were the best positive predictor of DLB at autopsy (positive predictive value: 83% versus 32% or less for all other variables), while lack of visuospatial impairment was the best negative predictor (negative predictive value: 90%). We conclude that the best model for differentiating DLB from Alzheimer's disease in the earliest stages of disease includes VH and visuospatial/constructional dysfunction, but not spontaneous EPS, as predictors. This suggests that clinical history plus a brief assessment of visuospatial function may be of the greatest value in correctly identifying DLB early during the course of disease.

Keywords: Alzheimer's disease; dementia with Lewy bodies; core clinical features; diagnostic accuracy.
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