Comparison of clinical manifestations in Alzheimer disease and dementia with Lewy bodies.
BACKGROUND
The clinical delineation of dementia with Lewy bodies (DLB) from Alzheimer disease (AD) remains unclear.


OBJECTIVE
To compare neuropsychological profiles in DLB and AD among Caribbean Hispanic family members and participants in a population-based epidemiologic sample using extended neuropsychological test batteries and to explore whether these differences were related to heritable factors.


METHODS
Cross-sectional study.


METHODS
Clinics in northern Manhattan (New York City), the Dominican Republic, and Puerto Rico.


METHODS
We compared measures of memory, orientation, language, and executive and visuospatial functioning between patients with DLB vs AD in 2 Caribbean Hispanic cohorts, including a family sample (89 patients with DLB and 118 patients with AD) and an epidemiologic sample (70 patients with DLB and 157 patients with AD). Patients with DLB in the family sample were further categorized as patients having at least 2 family members with DLB or as patients having 1 family member with DLB.


METHODS
To determine whether observed differences in cognitive profiles were driven by heritable factors, we repeated analyses in the epidemiologic sample after excluding familial cases. We applied general linear models adjusted for age, sex, educational level, disease duration, and apolipoprotein E epsilon4 (OMIM 104310) genotype.


RESULTS
Patients with DLB in both samples were more severely impaired in orientation, visuoconstruction, and nonverbal reasoning after controlling for potential confounders. Patients having at least 2 family members with DLB had the most severe impairment in memory, followed by patients having 1 family member with DLB, and then by patients with AD. After excluding familial AD and DLB cases in the epidemiologic sample, the differences between the groups persisted but were attenuated.


CONCLUSIONS
Compared with patients having AD, patients having DLB are more severely impaired in various cognitive domains, particularly orientation and visuospatial functioning. The difference seems stronger in familial DLB than in sporadic DLB. Whether this divergence in cognitive functions is caused by gene-gene or gene-environmental interactions remains unclear.
Nervi
Angela
A
Gertrude H. Sergievsky Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W 168th St, Columbia University, New York, NY 10032, USA.
Reitz
Christiane
C
Tang
Ming-Xin
MX
Santana
Vincent
V
Piriz
Angel
A
Reyes-Dumeyer
Dolly
D
Lantigua
Rafael
R
Medrano
Martin
M
Jiménez-Velázquez
Ivonne Z
IZ
Lee
Joseph H
JH
Mayeux
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology*; D053327:Apolipoprotein E4 / Q000235:genetics; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D005192:Family Health; D005260:Female; D006801:Humans; D007802:Language; D020961:Lewy Body Disease / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests; D009949:Orientation / Q000502:physiology; D011340:Problem Solving / Q000502:physiology; D011647:Puerto Rico / Q000453:epidemiology; D014796:Visual Perception / Q000502:physiology
D053327:Apolipoprotein E4