Depression associated with dementia with Lewy bodies (DLB) and the effect of somatotherapy.
BACKGROUND
Dementia with Lewy bodies (DLB) is a common type of dementia. It is difficult to make an initial diagnosis of DLB because of a variety of early symptoms, including psychosis-like and depressive states. In this study, we examined the characteristic depressive symptoms of the prestage of DLB and the efficacy and safety of somatotherapy for depression accompanying DLB.


METHODS
Subjects in the study were 167 consecutive clinical cases aged 50 years or more, hospitalized at Tsukuba University Hospital from December 2002 to September 2007. At the time of admission, patients were diagnosed with certain types of mood disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. For each subject, a series of neuropsychological tests, along with a standard psychiatric and neurological assessment and biological examinations, were conducted. Using the data from these exams, we diagnosed probable and possible DLB according to the criteria for dementia with Lewy bodies established by McKeith et al. 1 We compared patients' depressive symptoms according to the Hamilton Depression Scale, and distinguished between patients with depression associated with DLB and those with other mood disorders. 2 We also examined the efficacy and safety of somatotherapy (electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)) for patients with drug therapy-resistant depression associated with DLB.


RESULTS
1 The characteristic symptoms of patients with DLB were classified into two groups: psychotic and non-psychotic. The former consisted of patients with states such as delusion and agitation, and the latter included patients exhibiting psychomotor retardation, loss of insight and hypochondriasis. 2 Eight DLB patients with therapy-resistant depression underwent ECT. After ECT, significant improvement was observed, with no remarkable safety hazards. Six patients with drug therapy-resistant DLB underwent TMS. TMS appears to be an effective, safe remedy for this kind of patient.


CONCLUSIONS
A total of 13.8% of patients came to be re-diagnosed as having DLB as a consequence of a thorough examination after admission. Patients with depression associated with DLB were classified into psychotic and non-psychotic clusters. ECT and TMS are effective and safe therapeutic tools for drug therapy-resistant depression observed in DLB patients.
Takahashi
Sho
S
Clinical Neuroscience, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan. shotaka72@gmail.com
Mizukami
Katsuyoshi
K
Yasuno
Fumihiko
F
Asada
Takashi
T
D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003937:Diagnosis, Differential; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007564:Japan; D020961:Lewy Body Disease / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012449:Safety; D050781:Transcranial Magnetic Stimulation