Clinical diagnosis of Lewy body dementia

被引:34
作者
Surendranathan, Ajenthan [1 ]
Kane, Joseph P. M. [2 ]
Bentley, Allison [1 ]
Barker, Sally A. H. [3 ]
Taylor, John-Paul [4 ]
Thomas, Alan J. [3 ]
Allan, Louise M. [5 ]
McNally, Richard J. [6 ]
James, Peter W. [6 ]
McKeith, Ian G. [3 ]
Burn, David J. [7 ]
O'Brien, John T. [1 ]
机构
[1] Univ Cambridge, Dept Psychiat, Cambridge, England
[2] Queens Univ Belfast, Sch Med Dent & Biomed Sci, Belfast, Antrim, North Ireland
[3] Newcastle Univ, Translat & Clin Res Inst, Newcastle Upon Tyne, Tyne & Wear, England
[4] Newcastle Univ, Inst Neurosci, Newcastle Upon Tyne, Tyne & Wear, England
[5] Univ Exeter, Geriatr Med, Exeter, Devon, England
[6] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne, Tyne & Wear, England
[7] Newcastle Univ, Fac Med Sci, Newcastle Upon Tyne, Tyne & Wear, England
来源
BJPSYCH OPEN | 2020年 / 6卷 / 04期
基金
美国国家卫生研究院;
关键词
Dementia; clinical neurology; epidemiology; outpatient treatment; comorbidity; PARKINSONS-DISEASE; BODIES; PREVALENCE; DLB; I-123-FP-CIT; MANAGEMENT; CRITERIA; BURDEN;
D O I
10.1192/bjo.2020.44
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series. Aims This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences. Method We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions. Results The cases of individuals with DLB took longer to reach a final diagnosis (1.2v. 0.6 years,P= 0.017), underwent more scans (1.7v. 1.2,P= 0.002) and had more alternative prior diagnoses (0.8v. 0.4,P= 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1v. 1.5,P= 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P< 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs. Conclusions Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
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页数:8
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