title: Visuospatial deficits predict rate of cognitive decline in autopsy-verified dementia with Lewy bodies.
abstract: Dementia with Lewy bodies (DLB) is often characterized by pronounced impairment in visuospatial skills, attention, and executive functions. However, the strength of the phenotypic expression of DLB varies and may be weaker in patients with extensive concomitant Alzheimer's disease (AD). To determine whether strength of the DLB clinical phenotype impacts cognitive decline, visuospatial and language tests were retrospectively used to predict 2-year rate of global cognitive decline in 22 autopsy-confirmed DLB patients (21 with concomitant AD) and 44 autopsy-confirmed "pure" AD patients. Generalized estimating equations (GEE) revealed a significant interaction such that poor baseline performances on tests of visuospatial skills were strongly associated with a rapid rate of cognitive decline in DLB but not AD (p < .001). No effect of confrontation naming was found. DLB patients with poor visuospatial skills had fewer neurofibrillary tangles and were more likely to experience visual hallucinations than those with better visuospatial skills. These results suggest that the severity of visuospatial deficits in DLB may identify those facing a particularly malignant disease course and may designate individuals whose clinical syndrome is impacted more by Lewy body formation than AD pathology.
authors.affiliation: Department of Neurosciences, University of California, USA. jmhamilton@ucsd.edu
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Hamilton
authors.forename: David P
authors.initials: DP
authors.lastname: Salmon
authors.forename: Douglas
authors.initials: D
authors.lastname: Galasko
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.forename: Jenn
authors.initials: J
authors.lastname: Emond
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Hansen
authors.forename: Eliezer
authors.initials: E
authors.lastname: Masliah
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Thal
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology / Q000523:psychology*; D001344:Autopsy; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D003704:Dementia / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007807:Language Tests / Q000706:statistics & numerical data; D020961:Lewy Body Disease / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D016874:Neurofibrillary Tangles / Q000473:pathology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010468:Perceptual Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013028:Space Perception / Q000502:physiology; D014796:Visual Perception / Q000502:physiology