Abstract
ObjectivesDementia with Lewy bodies (DLB) is a major cause of degenerative dementia, yet the diagnosis is often missed or mistaken for Alzheimer's disease (AD). We assessed whether the revised Addenbrooke's Cognitive Examination (ACE‐R), a brief test for dementia, differentiates DLB from AD.MethodsWe first compared baseline ACE‐R performance in 76 individuals with DLB, 40 individuals with AD and 66 healthy controls. We then investigated the diagnostic accuracy of a simple standardised ‘memory/visuospatial’ ratio calculated from the ACE‐R subscores. Finally, as a comparison a logistic regression machine learning algorithm was trained to classify between DLB and AD.ResultsIndividuals with AD had poorer memory (p = 0.001) and individuals with DLB had poorer visuospatial function (p = 0.005). Receiver operating characteristics curves confirmed that the ACE‐R total score could differentiate dementia from non‐dementia cases with 98% accuracy, but could not discriminate between dementia types (50%, or chance‐level accuracy). However, a ‘memory/visuospatial’ ratio ≥1.1 differentiated DLB from AD with 82% sensitivity, 68% specificity and 77% mean accuracy. The machine learning classifier did not improve the overall diagnostic accuracy (74%) of the simple ACE‐R subscores ratio.ConclusionsThe ACE‐R‐based ‘memory/visuospatial’ ratio, but not total score, demonstrates good clinical utility for the differential diagnosis of DLB from AD.
Highlights
Dementia with Lewy bodies (DLB) is characterised by recurrent visual hallucinations, parkinsonian motor symptoms, rapid eye movement (REM) sleep behaviour disorder and fluctuating cognitive impairment.[1]
Identifying the presence of DLB by clinical assessment is further complicated by dementia due to co‐occurring Alzheimer's disease (AD).[3]
Sex ratio and years in education did not significantly differ between the DLB and AD groups. Participants in these groups were in mild‐to‐moderate disease stages, as reflected by total Addenbrooke's Cognitive Examination‐Revised (ACE‐R) and Mini‐Mental State Examination (MMSE) scores
Summary
Dementia with Lewy bodies (DLB) is characterised by recurrent visual hallucinations, parkinsonian motor symptoms, rapid eye movement (REM) sleep behaviour disorder and fluctuating cognitive impairment.[1] DLB is one of the major causes of degenerative dementia, early diagnosis remains challenging. Alzheimer's disease (AD) and movement disorders are among the most frequent misdiagnoses, largely due to shared symptomology (e.g., spontaneous extrapyramidal motor features2) and difficulty to detect cognitive impairment early. Identifying the presence of DLB by clinical assessment is further complicated by dementia due to co‐occurring AD.[3] Overlapping neuropsychiatric symptoms can lead to misdiagnosis.[4] Individuals with DLB may benefit from the treatment of Parkinsonism or other autonomic symptoms, but adversely react to neuroleptics, with increased morbidity and mortality in severe cases.[5] DLB specific management pathways have recently been developed,[6] but an accurate diagnosis is clearly needed for individuals to benefit from these
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