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Neurodegeneration
Research paper
Concomitant AD pathology affects clinical manifestation and survival in dementia with Lewy bodies
  1. A W Lemstra1,
  2. M H de Beer1,2,
  3. C E Teunissen3,
  4. C Schreuder4,
  5. P Scheltens1,
  6. W M van der Flier5,
  7. S A M Sikkes6
  1. 1Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands
  2. 2HagaZiekenhuis, Haga Hospital, The Hague, The Netherlands
  3. 3Department of Clinical Chemistry, VU University Medical Center & Alzheimer Center, Amsterdam, The Netherlands
  4. 4Department of Medical Psychology & Alzheimer center, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
  5. 5Alzheimer center & Department of Neurology and Department of Epidemiology and Biostatistics, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
  6. 6Alzheimer center & Department of Epidemiology and Biostatistics, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr A W Lemstra, Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus Amsterdam, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands; a.lemstra{at}vumc.nl

Abstract

Objective To investigate whether concomitant Alzheimer's disease (AD) pathology, reflected by cerebrospinal fluid (CSF) biomarkers, has an impact on dementia with Lewy bodies (DLB) in terms of clinical presentation, cognitive decline, nursing home admittance and survival.

Participants We selected 111 patients with probable DLB and CSF available from the Amsterdam Dementia Cohort. On the basis of the AD biomarker profile (CSF tau/amyloid-β 1–42 (Aβ42) ratio >0.52), we divided patients into a DLB/AD+ and DLB/AD– group. Of the 111 patients, 42 (38%) had an AD CSF biomarker profile. We investigated differences between groups in memory, attention, executive functions, language and visuospatial functions. Difference in global cognitive decline (repeated Mini-Mental State Examination (MMSE)) was investigated using linear mixed models. Cox proportional hazard analyses were used to investigate the effects of the AD biomarker profile on time to nursing home admittance and time to death.

Results Memory performance was worse in DLB/AD+ patients compared with DLB/AD− patients (p<0.01), also after correction for age and sex. Hallucinations were more frequent in DLB/AD+ (OR=3.34, 95% CI 1.22–9.18). There was no significant difference in the rate of cognitive decline. DLB/AD+ patients had a higher mortality risk (HR=3.13, 95% CI 1.57 to 6.24) and nursing home admittance risk (HR=11.70, 95% CI 3.74 to 36.55) compared with DLB/AD− patients.

Conclusions DLB-patients with a CSF AD profile have a more severe manifestation of the disease and a higher risk of institutionalisation and mortality. In clinical practice, CSF biomarkers may aid in predicting prognosis in DLB. In addition, DLB-patients with positive AD biomarkers could benefit from future treatment targeting AD pathology.

https://doi.org/10.1136/jnnp-2016-313775

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    Footnotes

    • Contributors AWL designed and conceptualised the study, interpreted the data and drafted and revised the manuscript. She is the guarantor. MHdB analysed and interpreted the data and drafted and revised the manuscript. CET revised the manuscript for intellectual content and supervised laboratory investigations. CS performed neuropsychological examinations and revised the manuscript for intellectual content. PS revised the manuscript for intellectual content. WMvdF revised the manuscript for intellectual content, interpreted the data and advised on methodology and statistical analyses. SAMS analysed and interpreted the data, advised on methodology and drafted and revised the manuscript.

    • Funding This research was funded by the Dutch Research Council (ZonMW/Memorabel—#733050509) and Alzheimer Nederland.

    • Competing interests AWL has received grant support from the Dutch Research Council (ZonMW), Alzheimer Nederland and Stichting Dioraphte. All funds are paid to her institution. No further competing interests to declare.

    • Ethics approval Medical Ethical Review Committee of the VU University Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.