Relative preservation of MMSE scores in autopsy-proven dementia with Lewy bodies.

Full Abstract

BACKGROUND: Recent studies raised questions about the severity of cognitive impairment associated with dementia with Lewy bodies (DLB). However, there have been few analyses of large, multicenter data registries for clinical-pathologic correlation. METHODS: We evaluated data from the National Alzheimer's Coordinating Center registry (n = 5,813 cases meeting initial inclusion criteria) and the University of Kentucky Alzheimer's Disease Center autopsy series (n = 527) to compare quantitatively the severity of cognitive impairment associated with DLB pathology vs Alzheimer disease (AD) and AD+DLB pathologies. RESULTS: Mini-Mental State Examination (MMSE) scores showed that persons with pure DLB had cognitive impairment of relatively moderate severity (final MMSE score 15.6 +/- 8.7) compared to patients with pure AD and AD+DLB (final MMSE score 10.7 +/- 8.6 and 10.6 +/- 8.6). Persons with pure DLB pathology from both data sets had more years of formal education and were more likely to be male. Differences in final MMSE scores were significant (p < 0.01) between pure DLB and both AD+DLB and pure AD even after correction for education level, gender, and MMSE-death interval. Even in cases with extensive neocortical LBs, the degree of cognitive impairment was most strongly related to the amount of concomitant AD-type neurofibrillary pathology. CONCLUSIONS: Dementia with Lewy bodies can constitute a debilitating disease with associated psychiatric, motoric, and autonomic dysfunction. However, neocortical Lewy bodies are not a substrate for severe global cognitive impairment as assessed by the Mini-Mental State Examination. Instead, neocortical Lewy bodies appear to constitute or reflect an additive disease process, requiring Alzheimer disease or other concomitant brain diseases to induce severe global cognitive deterioration.

Author information

Author/s: Nelson, P T (PT); Kryscio, R J (RJ); Jicha, G A (GA); Abner, E L (EL); Schmitt, F A (FA); Xu, L O (LO); Cooper, G (G); Smith, C D (CD); Markesbery, W R (WR);

Affiliation: Department of Pathology, Division of Neuropathology, University of Kentucky Medical Center, 800 S. Limestone, University of Kentucky, Lexington, KY 40536-0230, USA. pnels2(-atsign-)email.uky.edu

Grants: K08 NS050110 (Agency:NINDS NIH HHS) ; P30 AG028383 (Agency:NIA NIH HHS) ; R01 NS061933 (Agency:NINDS NIH HHS) ; U01 AG016976 (Agency:NIA NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Neurology (Neurology), published in United States. (Language: eng)

Reference: 2009-Oct; vol 73 (issue 14) : pp 1127-33

Dates: Created 2009/10/06; Completed 2009/10/30;

PMID: 19805729, status: MEDLINE (last retrieval date: 10/30/2009, IMS Date: )

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