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. 2012 May;39(3):304-10.
doi: 10.1017/s0317167100013421.

Clinical overlap between Jakob-Creutzfeldt disease and Lewy body disease

Maria Carmela Tartaglia  1 , David Y Johnson, Julie Ngoc Thai, Tatiana Cattaruzza, Katherine Wong, Paul Garcia, Stephen J Dearmond, Bruce L Miller, Michael D Geschwind
Affiliations

Clinical overlap between Jakob-Creutzfeldt disease and Lewy body disease

Maria Carmela Tartaglia et al. Can J Neurol Sci. 2012 May.

Abstract

Objective: Sporadic Jakob-Creutzfeldt disease (sCJD) and dementia with Lewy bodies (DLB) have overlapping clinical symptoms that can lead to their misdiagnosis. We delineated the clinical overlap between sCJD and DLB, and assessed the value of magnetic resonance imaging (MRI) to differentiate between them.

Methods: Medical records, MRI, electroencephalogram (EEG) and cerebrospinal fluid (CSF) were reviewed from 56 sCJD and 30 DLB subjects.

Results: 46% of sCJD subjects met probable DLB criteria and 40% of DLB subjects met probable CJD criteria. A greater proportion of sCJD subjects had cerebellar signs (66% vs. 10%, p<0.001), myoclonus (64% vs. 30%, p=0.002), and visual symptoms (other than hallucinations) (61% vs. 7%, p<0.001), whereas more DLB subjects had hallucinations (70% vs. 39%, p=0.007) and fluctuations (57% vs. 23%, p=0.002). Cortical and/or basal ganglia MRI diffusion weighted imaging hyperintensities consistent with sCJD were seen in 96% of sCJD subjects but in none with DLB. Logistic regression in sCJD revealed that those meeting probable DLB criteria were more likely to have occipital lobe involvement on MRI (OR 1.4, p=0.058, model p=0.022). Parietal lobe involvement on MRI was a predictor of "Other Focal Cortical signs" (OR 1.9, p=0.021). EEG and CSF assessments lacked sensitivity for sCJD as 48% of sCJD patients had a negative EEG; 67% of the 36 sCJD patents with a CSF evaluation had a negative or inconclusive 14-3-3 result. Too few DLB patients had EEG or CSF to assess their utility.

Conclusion: Sporadic CJD and DLB have significant symptom overlap. MRI helps differentiate these diseases and is related to the signs/symptoms observed in sCJD.

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Figures

Fig. 1
Fig. 1
Graph of sCJD vs. DLB for frequency of signs and symptoms in UCSF and WHO criteria for sCJD and McKeith criteria for DLB. * p<0.001; # p<0.01
See this image and copyright information in PMC

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