Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: A preliminary study

In several retrospective post-mortem studies, patients meeting clinical cri teria for Alzheimer's disease (AD) who gained the greatest cognitive benefi t from treatment with an acetylcholinesterase (AChE) inhibitor were found t o have neocortical Lewy bodies accompanying classical AD neuropathology. Th is 'dementia with Lewy bodies' (DLB) subtype manifests both parkinsonian an d psychopathologic features that set it apart from 'pure' AD (hereafter cal led AD). In the present preliminary study, 16 dementia patients were prospe ctively categorized as having DLB versus AD. Subjects were also categorized according to their profile on surface electromyographic (EMG) measures dem onstrated in prior work to be analogues of clinically observed parkinsonian extrapyramidal signs (EPS). All patients were prescribed the AChE inhibito r donepezil (5 mg per day). At baseline and at 6 months, patients underwent cognitive testing with the Mini-Mental State Examination (MMSE) while care givers assessed their psychopathologic status using the Behavioral Symptoms in Alzheimer's Disease (BEHAVE-AD) scale. The tester was blinded to the AD versus DLB classification of the patients. AD cases (N=12) had only a slig ht increase in cognitive scores, while DLB patients' (N=4) mean MMSE scores increased to a significantly greater degree. Furthermore, patients categor ized by EMG as EPS positive (N=8) attained an increase in their mean MMSE s core from baseline to 6 months that differed significantly from a decline i n MMSE: observed among their EPS negative (N=4) counterparts. Far all subje cts, an increase in MMSE scores across 6 months of treatment correlated wit h a decline in BEHAVE-AD scores. Copyright (C) 2000 John Wiley & Sons. Ltd.