Psychopathology at initial diagnosis in dementia with Lewy bodies versus Alzheimer disease: Comparison of matched groups with autopsy-confirmed diagnoses

Dementia with Lewy bodies (DLB) is believed to be the second most common form of dementia, after Alzheimer disease (AD). DLB has been reported to be associated with an increase in psychopathology; however, antemortem diagnosis of DLB cannot always be made with certainty. We searched the database of University of California, San Diego SOCARE (Seniors Only Care) outpatient program. There were 26 autopsy-confirmed cases of DLB. We matched them individually with 26 autopsy-confirmed cases of 'pure' AD on gender, ethnicity, and Mini-Mental State Examination score at the baseline evaluation. We compared the two groups on psychopathologic measures and possible risk factors for psychopathology based on the data obtained at the time of the initial diagnosis of dementia. Five psychiatric symptoms: hallucinations, delusions, anxiety, anhedonia, and loss of energy were significantly more common in DLB patients than in AD patients. DLB patients were younger at initial evaluation and death as compared to AD patients, but there was no difference in age of onset of dementia, level of education, or family or past history of any major neuropsychiatric disorder, prescription of psychotropic medications, or sensory impairment. Psychiatric symptoms were more common at time of initial diagnosis of dementia in DLB than in AD patients. This difference could not be attributed to any known risk factors for psychopathology examined. Psychopathology should be considered an integral part of DLB, and should be taken into account in the initial diagnosis of the type of dementia. Copyright (C) 2000 John Wiley and Sons, Ltd.