The temporal onset of the core features in dementia with Lewy bodies

Abstract

Introduction: We examined the temporal sequence of the core features in probable dementia with Lewy bodies (DLB).

Methods: In 488 patients with probable DLB, the onset of each core feature and time to diagnosis was determined for men and women, and a pathologic subgroup (n = 209).

Results: REM sleep behavior disorder (RBD) developed before the other core features in men and women. Men were more likely to have RBD and were diagnosed with probable DLB earlier than women. Visual hallucinations developed after the other core features in men, but in women, they appeared earlier and concurrently with fluctuations and parkinsonism. Women were older and more cognitively impaired at first visit, were less likely to have RBD, more likely to be diagnosed with probable DLB later than men, and more likely to have neocortical tangles.

Discussion: An earlier latency to probable DLB was associated with men, RBD, and Lewy body disease without neocortical tangles.

Keywords: Alzheimer's disease; Lewy body disease; neuropsychiatric; sex.

FIGURE 1

Cumulative frequency of the onset age for each of the four core features of dementia with Lewy bodies (DLB); (A) represents men (n = 370) and (B) represents women (n = 118)

FIGURE 2

Cumulative frequency of time from cognitive onset to each of the four core features of dementia with Lewy bodies (DLB); (A) represents men (n = 370) and (B) represents women (n = 118)

FIGURE 3

Illustration of the temporal sequence of each core DLB feature based on comparisons of median onset age and median latency from cognitive onset in men and women. Features to the right of each arrow represent older median onset ages and longer median latencies from cognitive onset compared to features to the left of each arrow (P < .001). Stacked features do not differ in median onset age or median latency from cognitive onset. DLB, dementia with Lewy bodies; RBD, REM sleep behavior disorder, VH, visual hallucinations [Correction added on December 21, 2021, after first online publication: In the initial publication of this article, the word “Parkinsonism” was omitted from the “Men” line in Figure 3. The word has now been added under “Fluctuations”.]