Abstract
Background: Dementia with Lewy bodies (DLB) is the second most common degenerative dementia in
older people. However, rates of misdiagnosis are high, and little is known of its natural history and
outcomes. Very few previous studies have been able to access routine clinical information for large,
unbiased DLB cohorts in order to establish initial presentation, neuropsychological profile and mortality.
Objective: To examine in detail, symptom patterns at presentation and their association with outcomes,
including mortality, in a large naturalistic DLB cohort from a secondary care sample. Methods: A
retrospective cohort design was used to identify a DLB cohort (n = 251) from Cambridgeshire and
Peterborough NHS Foundation Trust (CPFT). Information relating to first consultation, diagnosis, and DLB
diagnostic features were extracted. Results: A wide range of presenting complaints and differential initial
diagnoses were identified for the cohort. Along with memory loss (27.1%) and hallucinations (25.4%), low
mood (25.1%) was noted as a key presenting complaint among the DLB cohort. Rates of REM sleep
disorder were considerably lower (8.4%) than would be expected. Deficits in non-amnestic cognitive
domains were associated with reduced mortality compared with amnestic-only presentations. Conclusion:
Individuals later diagnosed with DLB present initially to secondary care with a wide range of symptoms
and complaints, some of which are not immediately suggestive of a DLB diagnosis. More examinations of
large cohorts such as this are needed to further elucidate the complex presentation and clinical course of
DLB, and to confirm whether amnestic-only presentation confers a worse outcome.
older people. However, rates of misdiagnosis are high, and little is known of its natural history and
outcomes. Very few previous studies have been able to access routine clinical information for large,
unbiased DLB cohorts in order to establish initial presentation, neuropsychological profile and mortality.
Objective: To examine in detail, symptom patterns at presentation and their association with outcomes,
including mortality, in a large naturalistic DLB cohort from a secondary care sample. Methods: A
retrospective cohort design was used to identify a DLB cohort (n = 251) from Cambridgeshire and
Peterborough NHS Foundation Trust (CPFT). Information relating to first consultation, diagnosis, and DLB
diagnostic features were extracted. Results: A wide range of presenting complaints and differential initial
diagnoses were identified for the cohort. Along with memory loss (27.1%) and hallucinations (25.4%), low
mood (25.1%) was noted as a key presenting complaint among the DLB cohort. Rates of REM sleep
disorder were considerably lower (8.4%) than would be expected. Deficits in non-amnestic cognitive
domains were associated with reduced mortality compared with amnestic-only presentations. Conclusion:
Individuals later diagnosed with DLB present initially to secondary care with a wide range of symptoms
and complaints, some of which are not immediately suggestive of a DLB diagnosis. More examinations of
large cohorts such as this are needed to further elucidate the complex presentation and clinical course of
DLB, and to confirm whether amnestic-only presentation confers a worse outcome.
| Original language | English |
|---|---|
| Pages (from-to) | 995-1005 |
| Number of pages | 11 |
| Journal | JOURNAL OF ALZHEIMERS DISEASE |
| Volume | 67 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 12 Feb 2019 |
Keywords
- Clinical presentation
- Dementia with Lewy bodies
- diagnostic features
- mortality
- retrospective cohort