Change in perfusion, hallucinations and fluctuations in consciousness in dementia with Lewy bodies.
Fluctuations in consciousness and visual hallucinations are common neuropsychiatric features of dementia with Lewy bodies and Parkinson's disease dementia. To investigate potential neural correlates, we compared how changes in brain perfusion over a 1-year period were related to changes in the severity of these key clinical features. We recruited 29 subjects with either Parkinson's disease with dementia (15 subjects) or dementia with Lewy bodies (14 subjects). Cerebral perfusion was measured using HMPAO SPECT at baseline, and repeated 1 year later. The presence of hallucinations (Neuropsychiatric Inventory), severity of fluctuations in consciousness (fluctuation assessment scale) and cognitive ability (CAMCOG) were assessed at both time points. After controlling for changes in cognitive ability and effect of cholinesterase medication, we found a significant correlation between an increase in perfusion in midline posterior cingulate and decrease in hallucination severity. There was also a significant correlation between increased fluctuations of consciousness and increased thalamic and decreased inferior occipital perfusion. We have identified important neural correlates of key clinical features in Lewy body dementia and postulate that the associations can be understood through the influence of the cholinergic system on attention.
O'Brien
John T
JT
Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
Firbank
Michael J
MJ
Mosimann
Urs P
UP
Burn
David J
DJ
McKeith
Ian G
IG
D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003244:Consciousness Disorders / Q000175:diagnosis / Q000453:epidemiology*; D000077265:Donepezil; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D009483:Neuropsychological Tests; D010091:Oximes; D010880:Piperidines / Q000627:therapeutic use; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
D002800:Cholinesterase Inhibitors; D007189:Indans; D010091:Oximes; D010880:Piperidines; D019275:Radiopharmaceuticals; C068296:hexamethylpropyleneamine oxime; D000077265:Donepezil