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P1‐437: COMPARISON OF CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF PATIENTS WITH AD, DLB AND MIXED AD AND DLB PATHOLOGY
Author(s) -
Chatterjee Atri,
Hirsch-Reinshagen Veronica,
Ducharme Blake,
Mousavi Ali,
Mackenzie Ian R.,
Robin Hsiung Ging-Yuek
Publication year - 2019
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 - 10.1016/j.jalz.2019.06.1042
Subject(s) - dementia with lewy bodies , pathological , neuropathology , autopsy , medicine , dementia , disease , demographics , medical diagnosis , pathology , pediatrics , dermatology , demography , sociology
Background: Patients with dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) lie on a continuum from neuropathology perspective, with a significant proportion of patients having coexistent pathologies. We investigated clinical and pathological characteristics in patients with autopsy-confirmed diagnosis of DLB, AD and coexistent AD & DLB (mixed A&D) pathology to identify how coexistence of pathologies affected the disease course. Methods: We reviewed records of patients who underwent autopsy at the UBC Hospital Clinic for Alzheimer’s disease between 2001 and 2017, and selected cases with pathological diagnoses of pure AD, pure DLB, or mixed A&D. Cases with coexistent severe cerebrovascular diseases were excluded. Thirty-one cases of AD, 7 cases of DLB and 24 cases of mixed A&D were identified for further analysis. We compared demographics, clinical characteristics, as well as accuracy of the clinical diagnosis and brain weight at autopsy between the pathological groups by ANOVA or cas appropriate. Results: Visuopatial difficulties (85%) and visual hallucinations (57%) were most common in patients with DLB, followed by mixed A&D (58%& 25%), and least common in AD (3.2% & 6.5%, p<0.01). Gait disturbance or falls were also more frequent (57.1%) in DLB, common (41.6%) in mixed A&D, but uncommon (6.5%) in AD. REM behavioural disorders were most common (42.9%) in DLB, less in mixed A&D (20.8%), compared to only 3.2% in AD (p1⁄40.01). Premortem clinical diagnosis of DLB was suspected in 71% of those with pure DLB, 33% of mixed A&D, and 6% of pure AD. Mean survival was shortest for DLB (7.1 yr), followed by mixed A&D (8.3 yr) and AD (10.7 yr, p<0.01). On pathologic examination, AD patients had a lower brain weight (11816166g) than those with mixed A&D (13106130g) or AD (14016167g). Conclusions: Coexistent AD & DLB pathology increases overlap of clinical presentation and significantly shortens survival. Large scale longitudinal studies with pathological confirmation of diagnoses are needed to better understand the clinical characteristics of patients with multiple pathologies.