Cognitive decline is faster in Lewy body variant than in Alzheimer's disease

John M Olichney, D. Galasko, D. P. Salmon, C. R. Hofstetter, L. A. Hansen, R. Katzman, L. J. Thal

Research output: Contribution to journalArticle

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Abstract

Objectives: To quantify the rate of cognitive decline on the Mini- Mental State Examination (MMSE) in autopsy-diagnosed Lewy body variant (LBV) of Alzheimer's disease (AD) cases. We hypothesized that LBV patients would have a faster cognitive decline and shorter survival compared with patients with pure AD. Background: Prior reports have shown extrapyramidal signs to be associated with a poorer prognosis in AD. It has been suggested that LBV is often characterized by a rapidly progressive course. Few data are available regarding the rate of cognitive decline in autopsy-confirmed LBV dementia cases. Methods: We searched the databases of the University of California- San Diego Alzheimer's Disease Research Center and the Consortium to Establish a Registry in Alzheimer's Disease (CERAD) for dementia cases with 1) an autopsy diagnosis of definite or probable AD (CERAD criteria) with concomitant Lewy bodies and 2) longitudinal MMSE assessments. This resulted in a series of 40 LBV cases and 148 AD cases without Lewy bodies, with comparable baseline MMSE scores, age, and education. The rate of cognitive decline was calculated as the baseline MMSE - final MMSE. Methods were devised to reduce floor effects on the MMSE. Results: The average rate of cognitive decline was -5.8 ± 4.5 points/y in LBV and -4.1 ± 3.0 points/y in AD (t-test, p < 0.01). The LBV group declined a similar amount on the MMSE (means, -10.0 versus -9.6 points) over a significantly shorter time interval (1.9 versus 2.7 years; p = 0.005) than did AD patients. At baseline, the mean MMSE scores were nearly identical (18.2 in LBV; 17.8 in AD), but on follow- up examinations approximately 1, 2, and 3 years later, there were intergroup mean differences of 1.8 points (two-tailed p = 0.19), 4.2 points (p = 0.04), and 5.6 points (p = 0.03), respectively. The LBV cases had shorter survival time from the onset of cognitive symptoms (7.7 ± 3.0 years versus 9.3 ± 3.5 years; p = 0.007) and a shorter mean survival after entry/baseline, which was of marginal significance (3.6 versus 4.1 years; p = 0.11). Conclusions: This study demonstrates that LBV is characterized by a faster cognitive decline and accelerated mortality compared with AD.

Original languageEnglish (US)
Pages (from-to)351-357
Number of pages7
JournalNeurology
Volume51
Issue number2
StatePublished - Aug 1998
Externally publishedYes

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Lewy Bodies
Alzheimer Disease
Autopsy
Survival
Registries
Lewy Body Variant of Alzheimer Disease
Cognitive Dysfunction
Lewy Body Disease
Neurobehavioral Manifestations
Databases
Education

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Olichney, J. M., Galasko, D., Salmon, D. P., Hofstetter, C. R., Hansen, L. A., Katzman, R., & Thal, L. J. (1998). Cognitive decline is faster in Lewy body variant than in Alzheimer's disease. Neurology, 51(2), 351-357.

Cognitive decline is faster in Lewy body variant than in Alzheimer's disease. / Olichney, John M; Galasko, D.; Salmon, D. P.; Hofstetter, C. R.; Hansen, L. A.; Katzman, R.; Thal, L. J.

In: Neurology, Vol. 51, No. 2, 08.1998, p. 351-357.

Research output: Contribution to journalArticle

Olichney, JM, Galasko, D, Salmon, DP, Hofstetter, CR, Hansen, LA, Katzman, R & Thal, LJ 1998, 'Cognitive decline is faster in Lewy body variant than in Alzheimer's disease', Neurology, vol. 51, no. 2, pp. 351-357.
Olichney JM, Galasko D, Salmon DP, Hofstetter CR, Hansen LA, Katzman R et al. Cognitive decline is faster in Lewy body variant than in Alzheimer's disease. Neurology. 1998 Aug;51(2):351-357.
Olichney, John M ; Galasko, D. ; Salmon, D. P. ; Hofstetter, C. R. ; Hansen, L. A. ; Katzman, R. ; Thal, L. J. / Cognitive decline is faster in Lewy body variant than in Alzheimer's disease. In: Neurology. 1998 ; Vol. 51, No. 2. pp. 351-357.
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abstract = "Objectives: To quantify the rate of cognitive decline on the Mini- Mental State Examination (MMSE) in autopsy-diagnosed Lewy body variant (LBV) of Alzheimer's disease (AD) cases. We hypothesized that LBV patients would have a faster cognitive decline and shorter survival compared with patients with pure AD. Background: Prior reports have shown extrapyramidal signs to be associated with a poorer prognosis in AD. It has been suggested that LBV is often characterized by a rapidly progressive course. Few data are available regarding the rate of cognitive decline in autopsy-confirmed LBV dementia cases. Methods: We searched the databases of the University of California- San Diego Alzheimer's Disease Research Center and the Consortium to Establish a Registry in Alzheimer's Disease (CERAD) for dementia cases with 1) an autopsy diagnosis of definite or probable AD (CERAD criteria) with concomitant Lewy bodies and 2) longitudinal MMSE assessments. This resulted in a series of 40 LBV cases and 148 AD cases without Lewy bodies, with comparable baseline MMSE scores, age, and education. The rate of cognitive decline was calculated as the baseline MMSE - final MMSE. Methods were devised to reduce floor effects on the MMSE. Results: The average rate of cognitive decline was -5.8 ± 4.5 points/y in LBV and -4.1 ± 3.0 points/y in AD (t-test, p < 0.01). The LBV group declined a similar amount on the MMSE (means, -10.0 versus -9.6 points) over a significantly shorter time interval (1.9 versus 2.7 years; p = 0.005) than did AD patients. At baseline, the mean MMSE scores were nearly identical (18.2 in LBV; 17.8 in AD), but on follow- up examinations approximately 1, 2, and 3 years later, there were intergroup mean differences of 1.8 points (two-tailed p = 0.19), 4.2 points (p = 0.04), and 5.6 points (p = 0.03), respectively. The LBV cases had shorter survival time from the onset of cognitive symptoms (7.7 ± 3.0 years versus 9.3 ± 3.5 years; p = 0.007) and a shorter mean survival after entry/baseline, which was of marginal significance (3.6 versus 4.1 years; p = 0.11). Conclusions: This study demonstrates that LBV is characterized by a faster cognitive decline and accelerated mortality compared with AD.",
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T1 - Cognitive decline is faster in Lewy body variant than in Alzheimer's disease

AU - Olichney, John M

AU - Galasko, D.

AU - Salmon, D. P.

AU - Hofstetter, C. R.

AU - Hansen, L. A.

AU - Katzman, R.

AU - Thal, L. J.

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N2 - Objectives: To quantify the rate of cognitive decline on the Mini- Mental State Examination (MMSE) in autopsy-diagnosed Lewy body variant (LBV) of Alzheimer's disease (AD) cases. We hypothesized that LBV patients would have a faster cognitive decline and shorter survival compared with patients with pure AD. Background: Prior reports have shown extrapyramidal signs to be associated with a poorer prognosis in AD. It has been suggested that LBV is often characterized by a rapidly progressive course. Few data are available regarding the rate of cognitive decline in autopsy-confirmed LBV dementia cases. Methods: We searched the databases of the University of California- San Diego Alzheimer's Disease Research Center and the Consortium to Establish a Registry in Alzheimer's Disease (CERAD) for dementia cases with 1) an autopsy diagnosis of definite or probable AD (CERAD criteria) with concomitant Lewy bodies and 2) longitudinal MMSE assessments. This resulted in a series of 40 LBV cases and 148 AD cases without Lewy bodies, with comparable baseline MMSE scores, age, and education. The rate of cognitive decline was calculated as the baseline MMSE - final MMSE. Methods were devised to reduce floor effects on the MMSE. Results: The average rate of cognitive decline was -5.8 ± 4.5 points/y in LBV and -4.1 ± 3.0 points/y in AD (t-test, p < 0.01). The LBV group declined a similar amount on the MMSE (means, -10.0 versus -9.6 points) over a significantly shorter time interval (1.9 versus 2.7 years; p = 0.005) than did AD patients. At baseline, the mean MMSE scores were nearly identical (18.2 in LBV; 17.8 in AD), but on follow- up examinations approximately 1, 2, and 3 years later, there were intergroup mean differences of 1.8 points (two-tailed p = 0.19), 4.2 points (p = 0.04), and 5.6 points (p = 0.03), respectively. The LBV cases had shorter survival time from the onset of cognitive symptoms (7.7 ± 3.0 years versus 9.3 ± 3.5 years; p = 0.007) and a shorter mean survival after entry/baseline, which was of marginal significance (3.6 versus 4.1 years; p = 0.11). Conclusions: This study demonstrates that LBV is characterized by a faster cognitive decline and accelerated mortality compared with AD.

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