Abstract
BackgroundDementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) are recognised to be under-recognised in clinical practice in the UK, with only one third to a half of expected cases diagnosed. We aimed to assess whether clinical diagnostic rates could be increased by the introduction of a structured assessment toolkit for clinicians.MethodsWe established baseline diagnostic rates for DLB and PDD in four memory clinics and three movement disorder/Parkinson’s disease (PD) clinics in two separate geographical regions in the UK. An assessment toolkit specifically developed to assist with the recognition and diagnosis of DLB and PDD was then introduced to the same clinical teams and diagnostic rates for DLB and PDD were reassessed.For assessing DLB diagnosis, a total of 3820 case notes were reviewed before the introduction of the toolkit, and 2061 case notes reviewed after its introduction. For PDD diagnosis, a total of 1797 case notes were reviewed before the introduction of the toolkit and 3405 case notes after it. Mean values and proportions were analysed using Student’s t test for independent samples and χ2 test, respectively.ResultsDLB was diagnosed in 4.6% of dementia cases prior to the introduction of the toolkit, and 6.2% of dementia cases afterwards, an absolute rise of 1.6%, equal to a 35% increase in the number of DLB cases diagnosed when using the toolkit (χ2 = 4.2, P = 0.041).The number of PD patients diagnosed with PDD was not found overall to be significantly different when using the toolkit: 9.6% of PD cases before and 8.2% of cases after its introduction (χ2 = 1.8, P = 0.18), though the ages of PD patients assessed after the toolkit’s introduction were lower (73.9 years vs 80.0 years, t = 19.2, p < 0.001).ConclusionIntroduction of the assessment toolkit was associated with a significant increase in the rate of DLB diagnosis, suggesting that a structured means of assessing symptoms and clinical features associated with DLB can assist clinicians in recognising cases. The assessment toolkit did not alter the overall rate of PDD diagnosis, suggesting that alternate means may be required to improve the rate of diagnosis of dementia in Parkinson’s disease.
Highlights
Lewy body dementia, consisting of dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), is the second most common neurodegenerative dementia in older people and comprises 15–20% of dementia cases in pathological studies [1, 2].the clinical prevalence of Lewy body dementia (LBD) is found to be much less, with systematic reviews reporting the prevalence of Dementia with Lewy bodies (DLB) to be 4.2–5% [3, 4] and PDD to be 3.6%, of all dementia cases [5]
Demographics In the DLB part of the study, from the period prior to the introduction of the toolkit, 3820 case notes were reviewed from memory clinics and 2140 dementia cases identified
In the PDD part of the study, from the period prior to the introduction of the toolkit 1797 case notes were reviewed from movement disorder or PD clinics across the two regions, with 1130 cases of Parkinson’s disease identified, consisting of 974 in the North East and 156 in East Anglia
Summary
Lewy body dementia, consisting of dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), is the second most common neurodegenerative dementia in older people and comprises 15–20% of dementia cases in pathological studies [1, 2].the clinical prevalence of Lewy body dementia (LBD) is found to be much less, with systematic reviews reporting the prevalence of DLB to be 4.2–5% [3, 4] and PDD to be 3.6%, of all dementia cases [5]. Consensus diagnostic criteria for DLB [7, 8] and PDD [9, 10], aid clinicians in assessing patients with suspected Lewy body dementia. These criteria depend on eliciting a number of symptoms and clinical signs supported by the use of biomarkers, a definitive diagnostic test is not yet available. Dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) are recognised to be under-recognised in clinical practice in the UK, with only one third to a half of expected cases diagnosed. We aimed to assess whether clinical diagnostic rates could be increased by the introduction of a structured assessment toolkit for clinicians
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