Parkinson's Disease Dementia and Dementia with Lewy Bodies Have Similar Neuropsychological Profiles

Abstract

Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are common causes of dementia worldwide. Although considered separate entities based on the relative temporal onset of motor symptoms vs. diagnosis of dementia, it is unknown if these diseases truly have distinct cognitive profiles. We hypothesized that patients divided into PDD and DLB categories strictly by temporal criteria would have different neuropsychological profiles. We investigated this question via neuropsychological testing of PDD and DLB patients at the University of Iowa. We performed retrospective chart analysis and review of neuropsychological testing of clinically diagnosed patients with PDD or DLB, who had presented to University of Iowa's dementia and movement disorder clinics. Forty-seven patients diagnosed by the treating neurologist as PDD or DLB were included. Neuropsychological performance was compared between groups, and as a function of the relative timing of the motor diagnosis vs. diagnosis of dementia. We found that both PDD and DLB patients showed severe deficits in executive function, visual-spatial processing, and verbal learning. However, we found no significant differences in neuropsychological performance between groups, and neuropsychological performance could not reliably account for the relative timing of motor diagnosis vs. diagnosis of dementia. Our data support the idea that DLB and PDD are on a neuropsychological spectrum.

Keywords: Lewy bodies; Parkinson’s disease dementia; cognitive; dementia; dementia with Lewy bodies; diagnosis; parkinsonism; synuclein.

Figure 1

Core features were compared between dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD). Pearson’s chi-square analysis showed no significant difference between the groups in visual hallucinations/illusions (p = 0.10), symptoms of rapid eye movement (REM) sleep behavior disorder (p = 0.12), or evidence of fluctuations (p = 0.45).

Figure 2

Box-and-whisker plots of DLB and PDD patients showing range of z-scores. Boxes represent z-scores from the 25th to 75th percentile. Whiskers represent the minimum and maximum z-scores. Abbreviations: DLB, Dementia with Lewy Bodies; PDD, Parkinson’s Disease Dementia; BVRT, Benton Visual Retention Test; AVLT, Rey Auditory Verbal Learning Test.