DEMENTIA WITH LEWY BODY (DLB) SYMPTOMS HIDDEN WITHIN THE DIAGNOSIS ‘DEMENTIA NOT OTHERWISE SPECIFIED’: A CROSS-SECTIONAL STUDY IN 40 SWEDISH NURSING HOMES

Abstract

Background: Dementia with Lewy Body (DLB) is a neurocognitive disorder with core features, such as Parkinsonism, visual hallucinations, and fluctuating cognition/ excessive daytime sleepiness, and supportive features, such as rapid eye movement sleep behaviour disorder. DLB is often misdiagnosed and unrecognized in elderly individuals. A diagnosis of DLB is important because of the risk of hypersensitivity for neuroleptic drugs. Moreover, appropriate treatment of symptoms can improve quality of life considerably for both the individual with DLB and their caregivers. Primary care uses often diagnose Dementia Not Otherwise Specified (NOS) that may lead to an increased risk of wrong medical treatment and lack of proper elderly care. Especially if the elderly had a misdiagnosed or undefined DLB symptomatology. We hypothesized that potential DLB symptoms were hidden within the Dementia NOS diagnosis. Methods: A questionnaire designed to cover the main DLB symptoms (according to DLB consensus criteria from 2005) was distributed to all 40 primary care nursing homes (NHs) and geographically entirely covering the third largest Swedish city. Nursing staff completed the questionnaires after receiving specifically designed teaching. Results: The participants were elderly (n=650) from all NHs (n=40) where 94% (n=610) were included of which (n=595) had available medical records. The mean age was 86.0 ± 7.5 years; 75% (n=467) were women. The prevalence of elderly with Dementia NOS was 20% (n=121), AD 19% (n=115), AD-Mix 16% (n=97), VaD 14% (n=85), DLB/PDD 5% (n=22) and in 26% (n=155) no formal dementia diagnosis was found. Finally, according to the questionnaire, 16% of all the participants had two or more main symptoms of DLB (2-4 DLB smp.) According to the questionnaire, the elderly with the Dementia NOS diagnosis 85% had 0-1 DLB smp. and 15% had 2-4 DLB smp. Conclusion: We conclude that within the dementia NOS diagnose elderly with hidden DLB symptoms constitute 15% leading to risk of potentially harmful medication. Recognizing signs of dementia with Lewy bodies could reduce the number of individuals with Dementia NOS diagnosis and give opportunity to more suitable and less potentially harmful medication in nursing homes. (Less)