Clinical Lewy body dementia and the impact of vascular components

Objective. To study the prevalence of patients fulfilling the clinical cons ensus criteria for dementia with Lewy bodies (DLB) in a dementia population followed up with postmortem examination. To compare the clinical and neuro pathological findings in the clinical Lewy body dementia (LBD) group with f indings in a clinically defined group with Alzheimer's disease (AD). Design. Medical records from 200 patients were studied retrospectively. Cli nical consensus criteria for DLB and clinical criteria for other dementias were applied. Setting. The majority of the cases were examined and cared for in psychoger iatric and psychiatric departments. Patients. The patients, who died betwee n 1985 and 1994, were part of a longitudinal dementia project. Each case wa s neuropathologically examined. Main outcome measures. Prevalence of clinical signs and neuropathology was compared between the clinical groups. Results. Forty-eight (24%) patients fulfilled the clinical criteria for DLB while 45 (22%) fulfilled the clinical criteria for Alzheimer's disease. Th e clinical LED group had a higher Hachinski score compared to the clinical AD group. They also showed a tendency towards a 'frontal profile' with disi nhibition, confusion, personality change and vocally disruptive behaviour. More than 80% of the AD and LED groups respectively exhibited Alzheimer pat hology. The LED group had frontal white matter pathology and degeneration o f the substantia nigra more often than the clinical AD group. Both LED and AD groups showed a progressive and marked increase in severity of dementia and decrease in ADL capacity according to an evaluation based on the Berger scale and Katz index. The condition of the LED group was significantly wor se earlier in dementia. Conclusion. The results of this study indicate that patients fulfilling the clinical criteria for DLB also exhibit clinical features of possible vascu lar origin and a frontal profile. Subcortical vascular pathology, nigral de generation and AD pathology in this group could partly explain the clinical features used to define DLB. Copyright (C) 2000 John Wiley & Sons, Ltd.