2010 issue 1

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Volume 19, issue 1

Original article

Diagnosing dementia with Lewy bodies in clinical practice

Stefan Krzymiński1, Grzegorz Rossa1, Mirosława Kordacka1
1. Wojewódzki Szpital Specjalistyczny dla Nerwowo i Psychicznie Chorych Samodzielny Publiczny Zakład Opieki Zdrowotnej w Ciborzu
Postępy Psychiatrii i Neurologii 2010, 19(1): 31–38
Keywords: dementia with Lewy bodies, clinical diagnosis

Abstract

Objective. An attempt was made to identify cases of dementia with Lewy bodies (DLB) on the grounds of medical records of psychogeriatric patients primarily diagnosed with other dementias. DLB is considered to be the second most common type of degenerative dementia after Alzheimer's disease (AD). Even though current clinical diagnostic criteria for DLB characterized by a considerable sensitivity and specificity seem to be relatively simple, DLB is seldom diagnosed in everyday clinical practice.
Method. The clinical diagnostic criteria for DLB were applied to data obtained from medical records of patients who had been diagnosed with some other type of dementia, mostly AD or vascular dementia (VaD). Using this approach 22 cases of probable or possible DLB were identified, with cognitive deficits accompanied by symptoms considered to be axial for DLB, i.e. fluctuations in cognitive functioning, parkinsonism, and visual hallucinations. The patients were compared with 22 cases of probable AD.
Results. The group identified as DLB cases differed from AD patients in a number of ways. Some of the differences achieved the level of statistical significance. Namely, AD patients performed significantly better on the task of copying a line drawing of overlapping pentagons, while the DLB group had significantly more symptoms supporting their diagnosis. Fluctuations turned out to be the most frequent axial symptom of DLB, occurring however significantly more often only as compared to visual hallucinations. Fluctuations were diagnosed using the Fluctuations Composite Scale [Ferman et al. 2004], and on the grounds of the MMSE scores variability.
Conclusions. It is feasible to diagnose DLB in everyday psychogeriatric practice. It is important not only to identify the symptoms considered to be axial for DLB, but also to establish that the patient with a relatively high level of cognitive functions is incapable of adequate copying the picture of pentagons.

Address for correspondence:
Dr Stefan Krzymiński
Cibórz 36/2, 66-213 Skąpe
e-mail: szpital@ciborz.eu