Open AccessPathologic Correlates of Dementia in Individuals with Lewy Body Disease
Author(s) -
Sonnen Joshua A.,
Postupdia,
Larson Eric B.,
Crane Paul K.,
Rose Shan E.,
Montine Kathleen S.,
Leverenz James B.,
Montine Thomas J.
Publication year - 2010
Publication title -
brain pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.986
H-Index - 132
eISSN - 1750-3639
pISSN - 1015-6305
DOI - 10.1111/j.1750-3639.2009.00371.x
Subject(s) - dementia , lewy body , autopsy , medicine , disease , dementia with lewy bodies , population , cognitive impairment , pathology , psychology , pediatrics , environmental health
Cognitive impairment and dementia are more common in patients with Parkinson disease (PD) than age‐matched controls and appear to become more frequent as PD progresses. However, estimates of dementia in patients with PD have varied widely, likely due in part to differences in case definition, case ascertainment and methodology. First, we review investigations of usual pathologic correlates of dementia in patients with brainstem (b) Lewy Body Disease (LBD) and report our findings from the initial 266 brain autopsies from a population‐based study of brain aging and incident dementia. Our results showed that 2.6% of subjects were diagnosed with PD during life but that 20% had bLBD at autopsy. Seventy percent of individuals with bLBD had high level of one or more cerebral pathologic changes significantly associated with dementia: Alzheimer's disease (AD), cerebral (c) LBD or microvascular brain injury (µVBI); these were commonly co‐morbid. Next we consider proposed contributors to cognitive impairment and dementia in the approximately 30% of patients with only bLBD, including regionally selective dendritic degeneration of neostriatal medium spiny neurons. Diseases contributing to cognitive impairment and dementia in patients with bLBD are heterogeneous, providing diagnostic challenges as well as multiple opportunities for successful intervention in patients with PD.