Levodopa response in dementia with lewy bodies: a 1-year follow-up study.
OBJECTIVE
To evaluate levodopa responsiveness in patients with probable dementia with Lewy bodies (DLB) compared to early Parkinson's disease (PD) patients.


METHODS
Twenty four cases with DLB and 21 with PD underwent a baseline assessment with UPDRS (sub-item II and III) and an acute levodopa challenge test. Positive response to acute levodopa test was defined as an improvement of at least 15% in the tapping test, and at least 25% in the walking test and rigidity or tremor score. Subsequently, all patients were treated continuously with levodopa and evaluated after 6 and 12 months by means of UPDRS II/III.


RESULTS
Positive response to the acute levodopa test was observed in 55% of DLB patients (acute DLB responders), and in 90% of PD patients (acute PD responders). Acute DLB responders showed increased latency, and reduction of both duration and amplitude of response to acute levodopa in comparison with acute PD responders. At the 6-month follow-up visit, acute DLB responders showed a greater motor benefit compared with acute DLB non-responders. This improvement was similar to that observed in PD patients. However, at 1-year follow-up acute DLB responders showed a faster worsening of UPDRS III scores compared with acute PD responders, implying a reduction of levodopa efficacy.


CONCLUSIONS
Positive response to acute levodopa test can occur in DLB patients and may be predictive of long-term benefit of chronic levodopa therapy, although the motor improvement is less impressive than in PD patients.
Lucetti
Claudio
C
Neurology Unit, Hospital of Viareggio, Italy.
Logi
Chiara
C
Del Dotto
Paolo
P
Berti
Caterina
C
Ceravolo
Roberto
R
Baldacci
Filippo
F
Dolciotti
Cristina
C
Gambaccini
Gianna
G
Rossi
Giuseppe
G
Bonuccelli
Ubaldo
U
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D020961:Lewy Body Disease / Q000188:drug therapy*; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy
D000978:Antiparkinson Agents; D007980:Levodopa