Objective: To study clinical and neuroimaging features of dementia with Lewy bodies (DLB) for optimal management and prognosis of the disease.

Background: Appropriate diagnosis of DLB is often a challenge. The clinical picture of the disease consists of combination of various syndromes. Cerebrovascular lesions are often found on MRI and autopsy in patients with DLB and less is known about its significance and contribution to clinical phenotype of the disease.

Method: We examined 70 patients that fulfilled clinical criteria of DLB. The clinical assessment included Montreal Cognitive Assessment scale (MoCA), Mini-mental State Examination (MMSE), Addenbrooke’s Cognitive Examination (ACE-R), IQCODE, Neuropsychiatric Inventory (NPI-4), University of Miami Parkinson’s Disease Hallucinations Questionnaire (UM-PDHQ), the motor section of the Unified Parkinson’s disease rating scale (UPDRS), orthostatic hypotension test,  sleep and disorders were assessed with RBD1Q, Epworth Sleepiness Scale, single-question screen for REM sleep behavior disorder (RBD1Q), the Epworth Sleepiness Scale (ESS). All patients were performed 1,5 T brain MRI. MRI revealed with moderate to severe white matter hyperintensities (WMH) in 43 participants. Patients were performed ultrasound assessment of flow-mediated vasodilation. Willebrand factor and lipid profile were also evaluated.

Results: According to cluster analysis based on clinical manifestations, onset of the disease, imaging features we divided all patients on 3 subtypes: 1) classical, 2) form with early psychotic manifestation, 3) atypical (DLB+AD). Patients with classical subtype had more core clinical features. The second subtype was characterized by early psychotic manifestation in patients with relatively preserved cognitive functions. Patients with third subtype had more severe cognitive dysfunction in relation to other clinical syndromes, and cognitive deficit was presented with mixed concomitant alzheimer-related clinical and neuroimaging features. WMH on MRI in patients with DLB were associated more likely with hyppocampal atrophy than vascular risk factors and vessel reactivity.

Conclusion: The differential approach to patients with DLB may improve early diagnosis of DLB, prognosis of the disease course and treatment effectiveness.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-neuroimaging-heterogeneity-of-dementia-with-lewy-bodies/