The University of Southampton
University of Southampton Institutional Repository

Attention and fluctuating attention in dementia with Lewy bodies and Alzheimer's disease

Attention and fluctuating attention in dementia with Lewy bodies and Alzheimer's disease
Attention and fluctuating attention in dementia with Lewy bodies and Alzheimer's disease
Background Attentional deficits are described in the consensus clinical criteria for the operationalized diagnosis of dementia with Lewy bodies (DLB) as characteristic of the condition. In addition, preliminary studies have indicated that both attentional impairments and fluctuation of attentional impairments are more marked in patients with DLB than in patients with Alzheimer disease (AD), although neuropsychological function has not previously been examined in a large prospective cohort with confirmed diagnostic accuracy against postmortem diagnosis.
Methods A detailed evaluation of attention and fluctuating attention was undertaken in 155 patients with dementia (85 with DLB and 80 with AD) from a representative hospital dementia case register and 35 elderly controls using the Cognitive Drug Research Computerized Assessment System for Dementia Patients computerized neuropsychological battery. Operationalized clinical diagnosis was made using the consensus criteria for DLB and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria for AD. High levels of sensitivity and specificity have been achieved for the first 50 cases undergoing postmortem examination.
Results The groups were well matched for severity of cognitive impairments, but the AD patients were older (mean age, 80 vs 78 years) and more likely to be female (55% vs 40%). Patients with DLB were significantly more impaired than patients with AD on all measures of attention and fluctuating attention (for all comparisons, t 2.5, P<.001), and patients from both dementia groups were significantly more impaired than elderly controls for all comparisons other than cognitive reaction time, which was significantly more impaired in DLB patients than controls but was comparable in controls and AD patients. There were, however, significant associations between the severity of cognitive impairment and the severity of both attentional deficits and fluctuations in attention.
Conclusions This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction time appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits.
0003-9942
977-982
Ballard, Clive
e244c4e5-5dd4-4c66-9efb-6bf2006bdb7e
O'Brien, John
0906821d-4431-47e6-8155-27de5d7f9612
Gray, Alistair
927f0e39-addd-426a-92bb-772ff2becb6a
Cormack, Franchesca
2aa51411-595b-4e09-9fd3-b9a086641249
Ayre, Gareth
3ec4e044-76de-4a5e-a2cd-29153e185bbe
Rowan, Elise
1ac60f1d-e00c-4382-afae-4ce0c1813d04
Thompson, Peter
c12103d9-d46c-464c-8904-5fbaaa499520
Bucks, Romola
aee41f56-d77c-44a1-a310-cc885edf149a
McKeith, Ian
f9916929-ec7a-4c00-b004-9758d10619e9
Walker, Matthew
93151cdd-86c2-4d36-ba16-79e8d6e17cf9
Tovee, Martin
a0909772-de14-4a27-9e78-af650d4dccf1
Ballard, Clive
e244c4e5-5dd4-4c66-9efb-6bf2006bdb7e
O'Brien, John
0906821d-4431-47e6-8155-27de5d7f9612
Gray, Alistair
927f0e39-addd-426a-92bb-772ff2becb6a
Cormack, Franchesca
2aa51411-595b-4e09-9fd3-b9a086641249
Ayre, Gareth
3ec4e044-76de-4a5e-a2cd-29153e185bbe
Rowan, Elise
1ac60f1d-e00c-4382-afae-4ce0c1813d04
Thompson, Peter
c12103d9-d46c-464c-8904-5fbaaa499520
Bucks, Romola
aee41f56-d77c-44a1-a310-cc885edf149a
McKeith, Ian
f9916929-ec7a-4c00-b004-9758d10619e9
Walker, Matthew
93151cdd-86c2-4d36-ba16-79e8d6e17cf9
Tovee, Martin
a0909772-de14-4a27-9e78-af650d4dccf1

Ballard, Clive, O'Brien, John, Gray, Alistair, Cormack, Franchesca, Ayre, Gareth, Rowan, Elise, Thompson, Peter, Bucks, Romola, McKeith, Ian, Walker, Matthew and Tovee, Martin (2001) Attention and fluctuating attention in dementia with Lewy bodies and Alzheimer's disease. Archives of Neurology, 58 (6), 977-982.

Record type: Article

Abstract

Background Attentional deficits are described in the consensus clinical criteria for the operationalized diagnosis of dementia with Lewy bodies (DLB) as characteristic of the condition. In addition, preliminary studies have indicated that both attentional impairments and fluctuation of attentional impairments are more marked in patients with DLB than in patients with Alzheimer disease (AD), although neuropsychological function has not previously been examined in a large prospective cohort with confirmed diagnostic accuracy against postmortem diagnosis.
Methods A detailed evaluation of attention and fluctuating attention was undertaken in 155 patients with dementia (85 with DLB and 80 with AD) from a representative hospital dementia case register and 35 elderly controls using the Cognitive Drug Research Computerized Assessment System for Dementia Patients computerized neuropsychological battery. Operationalized clinical diagnosis was made using the consensus criteria for DLB and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria for AD. High levels of sensitivity and specificity have been achieved for the first 50 cases undergoing postmortem examination.
Results The groups were well matched for severity of cognitive impairments, but the AD patients were older (mean age, 80 vs 78 years) and more likely to be female (55% vs 40%). Patients with DLB were significantly more impaired than patients with AD on all measures of attention and fluctuating attention (for all comparisons, t 2.5, P<.001), and patients from both dementia groups were significantly more impaired than elderly controls for all comparisons other than cognitive reaction time, which was significantly more impaired in DLB patients than controls but was comparable in controls and AD patients. There were, however, significant associations between the severity of cognitive impairment and the severity of both attentional deficits and fluctuations in attention.
Conclusions This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction time appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits.

Text
18565.pdf - Version of Record
Restricted to Repository staff only

More information

Published date: 2001

Identifiers

Local EPrints ID: 18565
URI: http://eprints.soton.ac.uk/id/eprint/18565
ISSN: 0003-9942
PURE UUID: f433add7-871b-421f-bd27-396bb86c3271

Catalogue record

Date deposited: 02 Dec 2005
Last modified: 27 Apr 2022 04:19

Export record

Contributors

Author: Clive Ballard
Author: John O'Brien
Author: Alistair Gray
Author: Franchesca Cormack
Author: Gareth Ayre
Author: Elise Rowan
Author: Peter Thompson
Author: Romola Bucks
Author: Ian McKeith
Author: Matthew Walker
Author: Martin Tovee

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×