Progression of Lewy body dementia can be seen in 6 months
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Use of common clinical instruments helped identify progression of Lewy body dementia clinical features like global cognition and parkinsonism during a 6-month observation period, according to findings published in Neurology.
“Compared with Alzheimer’s disease and Parkinson’s disease, there are relatively few symptomatic trials in Lewy body dementia and even fewer disease modifying trials,” Elie Matar, MD, BSc, PhD, of the department of psychiatry at University of Cambridge, told Healio Neurology. “Existing trials in Lewy body dementia rely mainly on cognitive endpoints, borrowing from the AD literature. However, patients with Lewy body dementia suffer not only from memory problems, but also experience a set of additional clinical features which characterize this disease.”
According to Matar, these "core" features include visual hallucinations, fluctuations, motor symptoms and sleep symptoms, namely REM sleep behavior disorder.
"It is these features that patients and their caregivers often complain about and contribute to the poor prognosis and higher caregiver burden associated with this disease," Matar added. "Therefore, it only makes sense that we should consider these features as potential symptom targets and as a way of tracking the progression of disease."
In a prospective, multicenter, randomized control trial, researchers analyzed data of 116 participants with Lewy body dementia (dementia with Lewy bodies (DLB) = 72; Parkinson’s disease dementia (PDD) = 44; average age 77.9 ± 7.2; 78.4% men), taken from the Diagnosis and Management of Neurodegenerative Dementia (DIAMOND-Lewy) Study.
Researchers measured cognition, motor parkinsonism, cognitive fluctuations, neuropsychiatric symptoms and sleep disturbance at baseline and at 3-month and 6-month follow ups. They also recorded medications and dosages at each visit.
Matar and colleagues created linear mixed models to measure clinical features and symptoms in patients using the Mini-Mental State Examination (MMSE), motor section of the Unified Parkinson’s disease rating scale (UPDRS-III), Dementia Cognitive Fluctuations Scale (DCFS) and the Neuropsychiatric Inventory (NPI).
At the 6-month mark, investigators observed a significant decline of 1.3 points on the MSSE (P = .002) in addition to other worsening features among patients. Motor parkinsonism worsened with an increase in UPDRS-III score of 3.2 points (P = .018), fluctuation severity increased in DCFS score of 1.3 points (P = .001), and sleep symptoms increased in NPI-sleep score of 1.2 points (P = .04). Although these clinical features progressed over the study, there was no difference in rates of change of scores between DLB and PDD.
Study limitations include lack of demographic data and the generalization of patients in different countries.
“At the level of the clinician and individual patients, this study shows that symptoms of Lewy body dementia can change over a 6-month period, and it is worth seeing them at least every 6 months or even more frequently to keep a close eye for changes in symptoms, such as fluctuations, motor symptoms and sleep disturbance, and treating symptomatically where possible,” Matar said.