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Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy-confirmed dementia with Lewy bodies

Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy-confirmed dementia with Lewy bodies
Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy-confirmed dementia with Lewy bodies
OBJECTIVE: This investigation was undertaken to clarify the neuropathological substrates of key psychiatric symptoms in dementia with Lewy bodies.
METHOD: The authors studied 112 autopsy-confirmed cases of dementia with Lewy bodies in patients who had had annual standardized clinical evaluations until their death. The relationships of persistent psychiatric symptoms (visual hallucinations, delusions, depression) to plaques (Consortium to Establish a Registry for Alzheimer’s Disease protocol), tangles (Braak staging), and Lewy bodies (consensus Lewy body staging) were evaluated. In addition, symptom frequency and persistent symptoms were compared in the patients with Lewy body dementia and 90 patients with autopsy-confirmed Alzheimer’s disease studied prospectively during life.
RESULTS: The main neuropathological correlate of persistent visual hallucinations was the presence of less severe tangle pathology, but there was no significant association between tangle pathology and persistent delusions. Lewy body staging was associated with the presence of persistent visual hallucinations and persistent delusions. All baseline psychiatric features were significantly more frequent in dementia with Lewy bodies than in Alzheimer’s disease, as were persistent visual hallucinations, but patients who had dementia with Lewy bodies and severe tangle pathology had a clinical symptom profile more similar to that of Alzheimer’s disease patients and were less likely to have neocortical Lewy bodies.
CONCLUSIONS: The modest proportion of patients with Lewy body dementia and more severe tangle pathology resembled Alzheimer’s disease patients clinically. Unlike Alzheimer’s disease, dementia with Lewy bodies showed a significant inverse association between tangle burden and psychosis.
1535-7228
843-849
Ballard, Clive
e244c4e5-5dd4-4c66-9efb-6bf2006bdb7e
Jacoby, Robin
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Del Ser, Teodoro
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Khan, M. Nadeem
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Munoz, David G.
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Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Nagy, Zsuzanna
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Perry, Elaine K.
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Joachim, Catherine
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Jaros, Evelyn
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O'Brien, John T.
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Perry, Robert H.
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McKeith, Ian G.
d10591da-19e5-4a1c-8d40-c175495bfbdb
Ballard, Clive
e244c4e5-5dd4-4c66-9efb-6bf2006bdb7e
Jacoby, Robin
c67a2b99-e910-4a33-ad26-624bf3a16284
Del Ser, Teodoro
e678c2a0-9174-44b2-9d24-21f66553ed8c
Khan, M. Nadeem
8c94f3f0-3815-479c-8c16-7a7302867004
Munoz, David G.
514dc0e2-ff66-4483-81b0-35b91f9d839f
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Nagy, Zsuzanna
5a6df161-66e3-4f57-9ced-5d0fe0fd65f9
Perry, Elaine K.
6ac4d5db-e9ed-4e4c-b7bf-29929cc42825
Joachim, Catherine
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Jaros, Evelyn
93b4fb37-33d7-4339-b1ab-96af751e6303
O'Brien, John T.
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Perry, Robert H.
84e6f6de-d033-4eff-a2d2-2dce8c131f6e
McKeith, Ian G.
d10591da-19e5-4a1c-8d40-c175495bfbdb

Ballard, Clive, Jacoby, Robin, Del Ser, Teodoro, Khan, M. Nadeem, Munoz, David G., Holmes, Clive, Nagy, Zsuzanna, Perry, Elaine K., Joachim, Catherine, Jaros, Evelyn, O'Brien, John T., Perry, Robert H. and McKeith, Ian G. (2004) Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy-confirmed dementia with Lewy bodies. American Journal of Psychiatry, 161 (5), 843-849. (doi:10.1176/appi.ajp.161.5.843).

Record type: Article

Abstract

OBJECTIVE: This investigation was undertaken to clarify the neuropathological substrates of key psychiatric symptoms in dementia with Lewy bodies.
METHOD: The authors studied 112 autopsy-confirmed cases of dementia with Lewy bodies in patients who had had annual standardized clinical evaluations until their death. The relationships of persistent psychiatric symptoms (visual hallucinations, delusions, depression) to plaques (Consortium to Establish a Registry for Alzheimer’s Disease protocol), tangles (Braak staging), and Lewy bodies (consensus Lewy body staging) were evaluated. In addition, symptom frequency and persistent symptoms were compared in the patients with Lewy body dementia and 90 patients with autopsy-confirmed Alzheimer’s disease studied prospectively during life.
RESULTS: The main neuropathological correlate of persistent visual hallucinations was the presence of less severe tangle pathology, but there was no significant association between tangle pathology and persistent delusions. Lewy body staging was associated with the presence of persistent visual hallucinations and persistent delusions. All baseline psychiatric features were significantly more frequent in dementia with Lewy bodies than in Alzheimer’s disease, as were persistent visual hallucinations, but patients who had dementia with Lewy bodies and severe tangle pathology had a clinical symptom profile more similar to that of Alzheimer’s disease patients and were less likely to have neocortical Lewy bodies.
CONCLUSIONS: The modest proportion of patients with Lewy body dementia and more severe tangle pathology resembled Alzheimer’s disease patients clinically. Unlike Alzheimer’s disease, dementia with Lewy bodies showed a significant inverse association between tangle burden and psychosis.

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Published date: May 2004

Identifiers

Local EPrints ID: 27530
URI: http://eprints.soton.ac.uk/id/eprint/27530
ISSN: 1535-7228
PURE UUID: cf7a3c8d-73db-4ef0-b725-d2794af17ea8
ORCID for Clive Holmes: ORCID iD orcid.org/0000-0003-1999-6912

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Date deposited: 27 Apr 2006
Last modified: 18 Feb 2021 16:53

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Contributors

Author: Clive Ballard
Author: Robin Jacoby
Author: Teodoro Del Ser
Author: M. Nadeem Khan
Author: David G. Munoz
Author: Clive Holmes ORCID iD
Author: Zsuzanna Nagy
Author: Elaine K. Perry
Author: Catherine Joachim
Author: Evelyn Jaros
Author: John T. O'Brien
Author: Robert H. Perry
Author: Ian G. McKeith

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