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Operational criteria for senile dementia of Lewy body type (SDLT)

  • I. G. McKeith (a1), R. H. Perry (a1), A. F. Fairbairn (a1), S. Jabeen (a1) and E. K. Perry (a1)...

Synopsis

Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD.

Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%.

Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.

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Corresponding author

1 Address for correspondence: Dr I. G. McKeith, Brighton Clinic, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE.

References

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Blessed, G., Roth, M. & Tomlinson, B. E. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry 114, 797811.
Brown, R. G. & Marsden, C. D. (1984). How common is dementia in Parkinson' s disease? Lancet ii, 12621265.
Burns, A., Luthert, P., Levy, R., Jacoby, R. & Lantos, P. (1990). Accuracy of clinical diagnosis of Alzheimer's disease. British Medical Journal 301, 1026.
Byrne, E. J., Lennox, G., Lowe, J. & Godwin-Austen, R. B. (1989). Diffuse Lewy body disease: clinical features in 15 cases. Journal of Neurology, Neurosurgery and Psychiatry 52, 709717.
Gibb, W. R. G., Esiri, M. M. & Lees, A. J. (1987). Clinical and pathological features of diffuse cortical Lewy body disease (Lewy body dementa). Brain 110, 11311153.
Gibb, W. R. G., Luthert, P. J., Janota, I. & Lantos, P. L. (1989). Cortical Lewy body dementia: clinical features and classification. Journal of Neurology, Neurosurgery and Psychiatry 52, 185192.
Hachinski, V. C., Illiff, L. D., Zilcha, I. E., Du Boulay, G. H., McAllister, V. L., Marshall, J., Ross, R. R. W. & Symon, L. (1975). Cerebral blood flow in dementia. Archives of Neurology 32, 632637.
Hansen, L., Salmon, D., Galasko, D., Masliah, E., Katzman, R., DeTeresa, R., Thal, L., Pay, M. M., Hofstetter, R., Klauber, M., Rice, V., Butters, N. & Alford, M. (1990). The Lewy body variant of Alzheimer's disease: a clinical and pathologic entity. Neurology 40, 18.
Hassler, R. (1938). Zür Pathologie der Paralysis agitatis und des postencephalitischen Parkinsonismus. Journal of Psychology and Neurology (Leipzig) 48, 387476.
Lennox, G., Lowe, J., Landon, M., Byrne, E. J., Mayer, R. J. & Godwin-Austen, R. B. (1989 a). Diffuse Lewy body disease: correlative neuropathology using anti-ubiquitin immunocytochemistry. Journal of Neurology, Neurosurgery and Psychiatry 52, 12361247.
Lennox, G., Lowe, J., Morrell, K., Landon, M. & Mayer, R. J. (1989 b). Anti-ubiquitin immunocytochemistry is more sensitive than conventional techniques in the detection of diffuse Lewy body disease. Journal of Neurology, Neurosugery and Psychiatry 52, 6771.
Lipowski, Z. J. (1980). Delirium: Acute Brain Failure in Man. C. C. Thomas: Springfield, Illinois.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. & Stadlan, D. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 34, 939944.
Perry, E. K., Kerwin, J., Perry, R. H., Irving, D., Blessed, G. & Fairbairn, A. (1990 a). Cerebral cholinergic activity is related to the incidence of visual hallucinations in senile dementia of Lewy body type. Dementia 1, 24.
Perry, E. K., Marshall, E., Kerwin, J., Smith, C. J., Jabeen, S., Cheng, A. V. & Perry, R. H. (1990 b). Evidence of a monoaminergic-cholinergic imbalance related to visual hallucinations in Lewy body dementia. Journal of Neurochemistry 55, 14541456.
Perry, E. K., Marshall, E., Perry, R. H., Irving, D., Smith, C. J., Blessed, G. & Fairbairn, A. F. (1990 c). Cholinergic and dopaminergic activities in senile dementia of Lewy body type. In Alzheimer's Disease and Associated Disorders 4 (2), 8795, Raven Press: New York.
Perry, R. H., Irving, D., Blessed, G., Perry, E. K. & Fairbairn, A. F. (1989 a). Clinically and pathologically distinct form of dementia in the elderly. Lancet i, 166.
Perry, R. H., Irving, D., Blessed, G., Perry, E. K. & Fairbairn, A. F. (1989 b). Senile dementia of Lewy body type and spectrum of Lewy body disease. Lancet i, 1088.
Perry, R. H., Irving, D., Blessed, G., Fairbairn, A. F. & Perry, E. K. (1990 a). A clinically and neuropathologically distinct form of Lewy body dementia in the elderly. Journal of Neurological Sciences 95, 119139.
Perry, R. H., Irving, D. & Tomlinson, B. E. (1990 b). Lewy body prevalence in the ageing brain: relationship to neuropsychiatric disorders, Alzheimer-type pathology and catecholaminergic nuclei. Journal of Neurological Sciences 100, 223233.
Robinson, R. A. (1981). Some applications of rating scales in dementia. In Alzheimer's Disease (ed. Glen, A. I. M. and Whalley, L. J.), pp. 108114. Churchill Livingstone: Edinburgh.
Smith, P. E. M., Irving, D. & Perry, R. H. (1990). Distribution and density of cortical Lewy bodies in Parkinson's disease: relationship to age and dementia.In Proceedings of 80th Meeting of the Neuropathological Society, Neuropathology and Applied Neurobiology 16, 542.
Tomlinson, B. E., Blessed, G. & Roth, M. (1970). Observations on the brains of demented old people. Journal of Neurological Sciences 11, 205242.
Williams, A. (1991). Predictive testing and Parkinson's disease. British Journal of Hospital Medicine 45, 193.
Woodard, J. S. (1962). Concentric lyaline inclusion body formation in mental disease: analysis of twenty-seven cases. Journal of Neuropathology and Experimental Neurology 21, 442449.

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