Objective: Investigate neuropsychiatric features of prodromal stage dementia among individuals diagnosed with Lewy body disease.

Background: There has been minimal investigation into the prodromal features dementia with Lewy bodies (DLB) and how they may differ from prodromal features of Parkinson’s disease (PD) dementia (PDD).

Method: The data analyzed for this investigation were collected as part of a large-scale prospective longitudinal study by the National Alzheimer’s Coordinating Center (NACC database is funded by NIA/NIH Grant U01 AG016976). We identified 110 non-demented participants who converted to DLB at a subsequent visit and 75 non-demented PD participants who converted to PDD at a subsequent visit. We compared the between-group prevalence of neuropsychiatric symptoms based on informant responses on the Neuropsychiatric Inventory Questionnaire (NPI-Q) at time of dementia diagnosis and up to 3 years preceding dementia diagnosis using Chi-Square or Fisher Exact Test analyses.

Results: Demographic variables are provided in Table 1. There were no significant between-group differences in age or education, but the DLB group contained a significantly higher percentage of males. The prevalences of irritability, agitation/aggression, and disinhibition were significantly higher in the DLB group 3 years prior to dementia diagnosis. There was no significant between-group difference in the informants’ reporting of motor symptoms prior to dementia diagnosis. Nighttime behaviors did not differ between the two groups, but were present in at least 1/3 of all participants in the two years preceding conversion to dementia (Table 2).

Conclusion: Prodromal DLB patients demonstrate a significantly higher prevalence of several neuropsychiatric symptoms than the pre-dementia PD patients, but the groups converge closer to dementia conversion. Consistent with the updated DLB diagnostic criteria [1], nighttime behaviors were present in at least 1/3 of participants with DLB up to three years prior to conversion to dementia. The ability to use neuropsychiatric symptoms to distinguish DLB and PDD in the years prior to a dementia diagnosis appears limited.

References: 1. McKeith IG, Boeve BF, Dickson DW, et al.; Dementia with Lewy Bodies Consortium. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurol. 2017;89:1-13.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-neuropsychiatric-symptoms-in-the-prodromal-stages-of-dementia-with-lewy-bodies-and-parkinsons-disease-dementia/