More severe functional impairment in dementia with lewy bodies than Alzheimer disease is related to extrapyramidal motor dysfunction.
OBJECTIVE
The objective of this study was to compare functional impairments in dementia with Lewy bodies (DLB) and Alzheimer disease (AD) and their relationship with motor and neuropsychiatric symptoms.


METHODS
The authors conducted a cross-sectional study of 84 patients with DLB or AD in a secondary care setting. Patients were diagnosed according to published criteria for DLB and AD. The Bristol Activities of Daily Living Scale (BADLS) was used to assess functional impairments. Participants were also assessed using the Unified Parkinson's Disease Rating Scale (motor section), the Neuropsychiatric Inventory, and the Mini-Mental Status Examination.


RESULTS
Patients with DLB were more functionally impaired and had more motor and neuropsychiatric difficulties than patients with AD with similar cognitive scores. In both AD and DLB, there were correlations between total BADLS scores and motor and neuropsychiatric deficits. There was more impairment in the mobility and self-care components of the BADLS in DLB than in AD, and in DLB, these were highly correlated with UPDRS score. In AD, orientation and instrumental BADLS components were most affected.


CONCLUSIONS
The nature of functional disability differs between AD and DLB with additional impairments in mobility and self-care in DLB being mainly attributable to extrapyramidal motor symptoms. Consideration of these is important in assessment and management. Activities of daily living scales for use in this population should attribute the extent to which functional disabilities are related to cognitive, psychiatric, or motor dysfunction.
McKeith
Ian G
IG
Institute for Ageing and Health, Newcastle General Hospital, Newcastle-Upon-Tyne, UK. i.g.mckeith@ncl.ac.uk
Rowan
Elise
E
Askew
Kristina
K
Naidu
Anitha
A
Allan
Louise
L
Barnett
Nicky
N
Lett
Debbie
D
Mosimann
Urs P
UP
Burn
David
D
O'Brien
John T
JT
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D001480:Basal Ganglia Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D001921:Brain / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires