Predictors of progression in patients with AD and Lewy bodies

Objective: To examine the differences in the pattern of progression between AD and AD with Lewy bodies (AD+LB). Methods: The authors examined predicto rs of functional and cognitive disability, institutionalization, and death, as well as time to the development of psychosis (e.g., delusions, hallucin ations), extrapyramidal signs (EPS), diurnal hypersomnia, and depression in 185 patients with definite AD and 60 with autopsy-confirmed AD+LB. In addi tion, they analyzed a selected group of patients who did not have comorbid systemic or CNS disease that may have affected progression of the disease ( AD = 98 versus AD+LB = 44). The mean follow-up was 58.91 +/- 35.2 months. R esults: All cases: Patients with AD+LB had faster time to the development o f EPS and diurnal hypersomnia, but not to the development of psychosis or d epression. The rate of cognitive and functional decline, time to institutio nalization, and physical survival was not different between AD+LB and AD. S elected cases: Patients with AD+LB developed earlier EPS and diurnal hypers omnia than AD patients, and there was a trend to develop earlier major depr ession, but no differences were noted in time to psychosis. Patients with A D+LB had a faster time to institutionalization than those with AD. The rate of cognitive and functional decline and physical survival was not differen t between AD+LB and AD in these selected cases. Conclusion: Patients with A D+LB can develop EPS and diurnal hypersomnia earlier and have faster time t o institutionalization than those with AD alone, but cognitive and function al decline and physical survival are similar between these two entities.