The progression of cognitive impairment in dementia with Lewy bodies, vascular dementia and Alzheimer's disease.
BACKGROUND
Little is known about the rate of progression or associations of cognitive impairment in dementia with Lewy bodies (DLB), or the associations of accelerated decline.


METHODS
Dementia patients from a case register were evaluated at baseline and 1 year follow-up using the Cambridge Assessment for Mental Disorders in the Elderly, section B (CAMCOG) and the Mini-Mental State Examination (MMSE) to determine the rate of cognitive decline. Operationalized clinical diagnoses were applied (NINCDS ADRDA for Alzheimer's disease (AD), NINCDS AIRENS for vascular dementia (VaD) and consensus criteria for DLB).


RESULTS
One hundred and ninety-three patients completed annual MMSE schedules (AD, 101; DLB, 64; VaD, 38), of whom 154 completed the CAMCOG. The magnitude of cognitive decline (MMSE, 4-5 points; CAMCOG, 12-14 points) was similar in each of the dementias. The strongest predictor of accelerated cognitive decline in DLB was the apolipoprotein E4 allele (17.5 vs 8.3 points decline on the CAMCOG).


CONCLUSIONS
Over 1 year, DLB, VaD and AD patients had similar rates of cognitive decline overall. Apolipoprotein E4 may be an important predictor of more rapid decline in DLB.
Ballard
C
C
Reader in Old Age Psychiatry, University of Newcastle, Newcastle General Hospital, Newcastle upon Tyne, UK. c.g.ballard@ncl.ac.uk
O'Brien
J
J
Morris
C M
CM
Barber
R
R
Swann
A
A
Neill
D
D
McKeith
I
I
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood / Q000523:psychology*; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000097:blood*; D003072:Cognition Disorders / Q000097:blood / Q000209:etiology*; D015140:Dementia, Vascular / Q000097:blood / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005819:Genetic Markers; D006801:Humans; D020961:Lewy Body Disease / Q000097:blood / Q000235:genetics / Q000523:psychology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D053327:Apolipoprotein E4; D001057:Apolipoproteins E; D005819:Genetic Markers