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The influence of cerebrovascular disease in dementia with Lewy bodies and Parkinson’s disease dementia
Author(s) -
Hijazi Zina,
Yassi Nawaf,
Watson Rosie
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039611
Subject(s) - dementia with lewy bodies , dementia , medicine , parkinson's disease , cerebral amyloid angiopathy , hyperintensity , lewy body , disease , pathology , cardiology , magnetic resonance imaging , radiology
Background Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), is a common form of neurodegenerative dementia. The frequency and influence of cerebrovascular disease in LBD is not well understood but may be an important contributor to symptoms and outcome. Method A comprehensive literature search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines using the electronic databases Medline and Embase. Studies included assessed the presence and/or location of cerebrovascular lesions using either MRI or neuropathological examination of DLB or PDD. Specific lesions considered included white matter hyperintensities (WMH), cerebral amyloid angiopathy (CAA), cerebral microbleeds (CMB), macroscopic infarcts, microinfarcts and intracerebral haemorrhage. Result Of the search results (N=3923 articles), 53 were relevant, including 25 studies on WMH (DLB n=438, PDD n=532), 15 on CMB (DLB n=253 PDD n=197) and 12 examining microinfarcts (DLB n=186, PDD n=18). Most studies on WMH reported an increased severity of WMH in DLB compared to PDD, PD and healthy controls, and in PDD compared to PD using visual rating scales. In PD, WMH were associated with progression to PDD in longitudinal studies. CMB were more prevalent in DLB (17‐45%) compared to PDD and healthy controls, and in PDD compared to PD. There was an increased prevalence of microinfarcts in DLB (15‐80%) compared with controls. LBD did not appear to affect the prevalence of gross or lacunar infarcts or intracerebral haemorrhage. Some studies reported that WMH and CMB were associated with lower scores on neuropsychological testing in DLB. Conclusion Differing cerebrovascular lesion types and detection methods in the studies limit conclusions, with some conflicting results. There was an increased prevalence of certain cerebrovascular lesions in DLB compared to PDD, PD and controls, and in PDD compared to PD and control participants. The influence of cerebrovascular disease on the risk of LBD, disease progression and interaction with other co‐pathologies (e.g. Aβ, tau) is an important area for future research.