Fact-finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies

Abstract

Background: We performed a questionnaire survey of medical doctors engaged in the management of dementia to identify the actual status of treatment for dementia with Lewy bodies (DLB) in Japan.

Methods: Among participating medical doctors, we selected neurologists (Group N) and psychiatrists (Group P) because these physicians are usually involved in the management of DLB patients. The two groups were compared based on their diagnosis and treatment of DLB and in particular, parkinsonism.

Results: Neurological examinations and biomarker tests were less frequently performed by Group P than Group N. Antipsychotics and other psychotropics excluding anti-dementia drugs were significantly more frequently administered by Group P than Group N. The proportion of physicians who selected L-dopa as a first-line therapy for parkinsonism was significantly higher in Group N than in Group P. Despite these between-group differences, the following findings were common to the two groups: there was a discrepancy between the symptom that patients expressed the greatest desire to treat, and the awareness of physicians regarding the treatment of these symptoms; the initial agent was L-dopa; and physicians exercised caution against the occurrence of hallucinations, delusions, and other adverse drug reactions.

Conclusions: The results of the present survey offer valuable insight for the formulation of future DLB therapeutic strategies.

Keywords: Lewy bodies; dementia; levodopa; neurologists; psychiatrists; surveys and questionnaires.

Figure 1

Types of parkinsonism noted in patients with dementia with Lewy bodies (DLB). Q4. Regarding parkinsonian symptoms in DLB patients, please indicate the proportion of patients presenting with each of the symptoms listed below, when the proportion of patients with parkinsonian symptoms is taken as 100. Differences in population rates were tested (unpaired). *P < 0.01 vs. tremor, neurology; **P < 0.01 vs. tremor, psychiatry. pt, patients

Figure 2

Disturbed activities of daily living areas in dementia with Lewy bodies (DLB) patients. Q6. When the proportion of DLB patients who present with parkinsonian symptoms is taken as 100, please indicate the proportion of patients in whom each of the activities of daily living listed below is disturbed by the parkinsonian symptoms. pt, patients.

Figure 3

Discrepancy between parkinsonism symptoms which dementia with Lewy bodies (DLB) patients want to treat and symptoms to which physicians consider to give the highest treatment priority. Discrepancy between the prioritised parkinsonian symptoms in DLB patients to be treated and the parkinsonian symptoms DLB patients want to treat (Q5 vs. Q8SQ1). [Correction added on 3 July 2019, after first online publication: Titles of the left and right graphs have been corrected.]

Figure 4

Matters given the greatest importance by physicians when they select medications for the treatment of parkinsonism accompanying dementia with Lewy bodies (DLB). Q19. Please indicate the matter you attach the greatest importance to when you select therapeutic drugs for parkinsonian symptoms associated with DLB. [Correction added on 3 July 2019, after first online publication: Image and caption of Figure 4 have been corrected.]

Figure 5

First‐line therapies for parkinsonism accompanying dementia with Lewy bodies (DLB). Q10. First‐line drugs prescribed for treatment of parkinsonian symptoms in DLB patients. Differences in population rates were tested (unpaired). Neurology vs. psychiatry, significant difference, *P < 0.01. [Correction added on 3 July 2019, after first online publication: Image and caption of Figure 5 have been corrected.]

Figure 6

Types of psychotropics prescribed for the past 6 months in Group P.