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Qualitative performance characteristics differentiate dementia with Lewy bodies and Alzheimer's disease

Greater Manchester Neuroscience Centre, Hope Hospital, Salford, UK

Correspondence to:
Correspondence to:
Dr J Snowden, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Hope Hospital, Salford M6 8HD, UK;
julie.snowden{at}man.ac.uk

Methods: Forty one patients with clinically defined DLB were matched with 26 patients with AD for age, illness duration, nature and severity of cognitive deficits, and regional blood flow distribution on SPECT. The presence or absence of a set of qualitative performance characteristics, observed and recorded during the patients' initial cognitive evaluation, was identified by retrospective analysis of patients' records and the groups compared.

Results: Inattention, visual distractibility, impairments in establishing and shifting mental set, incoherence, confabulatory responses, perseveration, and intrusions were significantly more common in DLB than AD. Intrusions were particularly common in DLB, occurring in 78% of the group. They included externally cued intrusions arising from the visual environment, a feature never seen in AD. In a stepwise logistic regression analysis impaired mental set shifting, perseveration, and the presence of intrusions correctly classified 79% of patients.

Conclusion: It is possible to differentiate DLB and AD on the basis of qualitative features of performance. As many features are amenable to detection at clinical interview, they ought to contribute to clinicians' diagnostic armoury, leading to improved clinical recognition of DLB.

Keywords: dementia with Lewy bodies; Alzheimer's disease; intrusions

Abbreviations: DLB, dementia with Lewy bodies; AD, Alzheimer's disease; SPECT, single photon emission tomography; MMSE, mini mental state examination; CDR, clinical dementia rating

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