Abstract
IntroductionCompared to Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care. Yet, few investigations have been performed on comorbidities and risk factors of DLB. Therefore, we aimed to compare clinical risk factors and comorbidity profile in DLB and AD patients using two nationwide registries.MethodsThis is a linkage study between the Swedish dementia registry (SveDem) and the Swedish National Patient Registry conducted on 634 subjects with DLB and 9161 individuals with AD registered during the years 2007–2012. Comorbidity profile has been coded according to the International Classification of Diseases version 10 (ICD 10) in addition to the date of each event. The main chapters of the ICD-10, the Charlson score of comorbidities and a selected number of neuropsychiatric diseases were compared between the DLB and AD groups. Comorbidity was registered before and after the dementia diagnosis.Results“Mental and behavioral disorders”, “diseases of the nervous system”, “diseases of the eye and adnexa”, diseases of the “circulatory”, “respiratory”, and “genitourinary” systems, “diseases of the skin and subcutaneous tissue” and “diseases of the musculoskeletal system and connective tissue” occurred more frequently in the DLB group after multivariate adjustment. Depression [adjusted OR = 2.12 (95%CI 1.49 to 3.03)] and migraine [adjusted OR = 3.65 (95%CI 1.48 to 9.0)] were more commonly recorded before the diagnosis of dementia in the DLB group. Following dementia diagnosis, ischemic stroke [adjusted OR = 1.89 (95%CI 1.21 to 2.96)] was more likely to happen among the DLB patients compared to the AD population.ConclusionsOur study indicated a worse comorbidity profile in DLB patients with higher occurrence of depression, stroke and migraine compared with the AD group. Deeper knowledge about the underlying mechanisms of these associations is needed to explore possible reasons for the different pattern of comorbidity profile in DLB compared to AD and their prognostic significance.
Highlights
Compared to Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care
Depression has been suggested as a risk factor for DLB [9] and was more likely to persist over time in DLB subjects compared with AD patients [11]
The majority of patients are registered through specialist care units and the type of dementia is recorded as earlyonset AD, late-onset AD, mixed AD, vascular dementia, DLB, frontotemporal dementia, Parkinson’s disease with dementia, unspecified dementia or others
Summary
Compared to Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care. We aimed to compare clinical risk factors and comorbidity profile in DLB and AD patients using two nationwide registries. Compared with AD, DLB is associated with poorer prognosis, shorter time to nursing home admission, higher care burden and higher healthcare costs [2,3,4]. Comorbid diseases significantly increase utilization of healthcare resources [2], predict key outcomes of acute hospital care in older people [6] and are associated with a higher risk of death after dementia diagnosis [7]. Previous studies showed that occurrence of depression [8,9] and anxiety [10] is higher in DLB patients when compared with AD. History of stroke and anxiety has been reported to occur more often in DLB patients than in healthy controls, but not in comparison with AD patients [9]
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