Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease

T. J. Ferman, Z. Arvanitakis, H. Fujishiro, R. Duara, F. Parfitt, M. Purdy, C. Waters, W. Barker, N. R. Graff-Radford, D. W. Dickson

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To determine whether the temporal onset of visual phenomena distinguishes Lewy body disease (LBD) from Alzheimer's disease (AD), and to characterize the extent Lewy bodies and neurofibrillary tangles are associated with these clinical features. Methods: Consecutive cases of autopsy-confirmed LBD (n = 41), AD (n = 70), and AD with amygdala-predominant Lewy bodies (AD-ALB) (n = 14) with a documented clinical history of dementia were included. We mailed questionnaires to next-of-kin asking about symptoms during life. Lewy pathology and neurofibrillary tangle pathology were assessed. Results: The occurrence of visual hallucinations, misperceptions and family misidentification did not distinguish LBD from AD or AD-ALB, but the onset was earlier in LBD compared to AD and AD-ALB. When visual hallucinations developed within the first 5 years of dementia, the odds were 4-5 times greater for autopsy-confirmed LBD (or intermediate/high likelihood dementia with Lewy bodies) and not AD or AD-ALB. In LBD, limbic but not cortical Lewy body pathology was related to an earlier onset of visual hallucinations, while limbic and cortical Lewy body pathology were associated with visual misperceptions and misidentification. Cortical neurofibrillary tangle burden was associated with an earlier onset of misidentification and misperceptions in LBD and AD, but only with earlier visual hallucinations in AD/AD-ALB. Conclusion: When visual hallucinations occur within the first 5 years of the dementia, a diagnosis of LBD was more likely than AD. Visual hallucinations in LBD were associated with limbic Lewy body pathology. Visual misperceptions and misidentification delusions were related to cortical Lewy body and neurofibrillary tangle burden in LBD and AD/AD-ALB.

Original languageEnglish
Pages (from-to)227-231
Number of pages5
JournalParkinsonism and Related Disorders
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2013
Externally publishedYes

Fingerprint

Lewy Body Disease
Hallucinations
Dementia
Alzheimer Disease
Pathology
Lewy Bodies
Neurofibrillary Tangles
Autopsy
Delusions
Amygdala

Keywords

  • Alzheimer's disease
  • Dementia with Lewy bodies
  • Lewy body disease

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease. / Ferman, T. J.; Arvanitakis, Z.; Fujishiro, H.; Duara, R.; Parfitt, F.; Purdy, M.; Waters, C.; Barker, W.; Graff-Radford, N. R.; Dickson, D. W.

In: Parkinsonism and Related Disorders, Vol. 19, No. 2, 01.02.2013, p. 227-231.

Research output: Contribution to journalArticle

Ferman, TJ, Arvanitakis, Z, Fujishiro, H, Duara, R, Parfitt, F, Purdy, M, Waters, C, Barker, W, Graff-Radford, NR & Dickson, DW 2013, 'Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease', Parkinsonism and Related Disorders, vol. 19, no. 2, pp. 227-231. https://doi.org/10.1016/j.parkreldis.2012.10.013
Ferman, T. J. ; Arvanitakis, Z. ; Fujishiro, H. ; Duara, R. ; Parfitt, F. ; Purdy, M. ; Waters, C. ; Barker, W. ; Graff-Radford, N. R. ; Dickson, D. W. / Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease. In: Parkinsonism and Related Disorders. 2013 ; Vol. 19, No. 2. pp. 227-231.
@article{6b9ae4e7b32547158c6a741d7e43e7f9,
title = "Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease",
abstract = "Objective: To determine whether the temporal onset of visual phenomena distinguishes Lewy body disease (LBD) from Alzheimer's disease (AD), and to characterize the extent Lewy bodies and neurofibrillary tangles are associated with these clinical features. Methods: Consecutive cases of autopsy-confirmed LBD (n = 41), AD (n = 70), and AD with amygdala-predominant Lewy bodies (AD-ALB) (n = 14) with a documented clinical history of dementia were included. We mailed questionnaires to next-of-kin asking about symptoms during life. Lewy pathology and neurofibrillary tangle pathology were assessed. Results: The occurrence of visual hallucinations, misperceptions and family misidentification did not distinguish LBD from AD or AD-ALB, but the onset was earlier in LBD compared to AD and AD-ALB. When visual hallucinations developed within the first 5 years of dementia, the odds were 4-5 times greater for autopsy-confirmed LBD (or intermediate/high likelihood dementia with Lewy bodies) and not AD or AD-ALB. In LBD, limbic but not cortical Lewy body pathology was related to an earlier onset of visual hallucinations, while limbic and cortical Lewy body pathology were associated with visual misperceptions and misidentification. Cortical neurofibrillary tangle burden was associated with an earlier onset of misidentification and misperceptions in LBD and AD, but only with earlier visual hallucinations in AD/AD-ALB. Conclusion: When visual hallucinations occur within the first 5 years of the dementia, a diagnosis of LBD was more likely than AD. Visual hallucinations in LBD were associated with limbic Lewy body pathology. Visual misperceptions and misidentification delusions were related to cortical Lewy body and neurofibrillary tangle burden in LBD and AD/AD-ALB.",
keywords = "Alzheimer's disease, Dementia with Lewy bodies, Lewy body disease",
author = "Ferman, {T. J.} and Z. Arvanitakis and H. Fujishiro and R. Duara and F. Parfitt and M. Purdy and C. Waters and W. Barker and Graff-Radford, {N. R.} and Dickson, {D. W.}",
year = "2013",
month = "2",
day = "1",
doi = "10.1016/j.parkreldis.2012.10.013",
language = "English",
volume = "19",
pages = "227--231",
journal = "Parkinsonism and Related Disorders",
issn = "1353-8020",
publisher = "Elsevier BV",
number = "2",

}

TY - JOUR

T1 - Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer's disease

AU - Ferman, T. J.

AU - Arvanitakis, Z.

AU - Fujishiro, H.

AU - Duara, R.

AU - Parfitt, F.

AU - Purdy, M.

AU - Waters, C.

AU - Barker, W.

AU - Graff-Radford, N. R.

AU - Dickson, D. W.

PY - 2013/2/1

Y1 - 2013/2/1

N2 - Objective: To determine whether the temporal onset of visual phenomena distinguishes Lewy body disease (LBD) from Alzheimer's disease (AD), and to characterize the extent Lewy bodies and neurofibrillary tangles are associated with these clinical features. Methods: Consecutive cases of autopsy-confirmed LBD (n = 41), AD (n = 70), and AD with amygdala-predominant Lewy bodies (AD-ALB) (n = 14) with a documented clinical history of dementia were included. We mailed questionnaires to next-of-kin asking about symptoms during life. Lewy pathology and neurofibrillary tangle pathology were assessed. Results: The occurrence of visual hallucinations, misperceptions and family misidentification did not distinguish LBD from AD or AD-ALB, but the onset was earlier in LBD compared to AD and AD-ALB. When visual hallucinations developed within the first 5 years of dementia, the odds were 4-5 times greater for autopsy-confirmed LBD (or intermediate/high likelihood dementia with Lewy bodies) and not AD or AD-ALB. In LBD, limbic but not cortical Lewy body pathology was related to an earlier onset of visual hallucinations, while limbic and cortical Lewy body pathology were associated with visual misperceptions and misidentification. Cortical neurofibrillary tangle burden was associated with an earlier onset of misidentification and misperceptions in LBD and AD, but only with earlier visual hallucinations in AD/AD-ALB. Conclusion: When visual hallucinations occur within the first 5 years of the dementia, a diagnosis of LBD was more likely than AD. Visual hallucinations in LBD were associated with limbic Lewy body pathology. Visual misperceptions and misidentification delusions were related to cortical Lewy body and neurofibrillary tangle burden in LBD and AD/AD-ALB.

AB - Objective: To determine whether the temporal onset of visual phenomena distinguishes Lewy body disease (LBD) from Alzheimer's disease (AD), and to characterize the extent Lewy bodies and neurofibrillary tangles are associated with these clinical features. Methods: Consecutive cases of autopsy-confirmed LBD (n = 41), AD (n = 70), and AD with amygdala-predominant Lewy bodies (AD-ALB) (n = 14) with a documented clinical history of dementia were included. We mailed questionnaires to next-of-kin asking about symptoms during life. Lewy pathology and neurofibrillary tangle pathology were assessed. Results: The occurrence of visual hallucinations, misperceptions and family misidentification did not distinguish LBD from AD or AD-ALB, but the onset was earlier in LBD compared to AD and AD-ALB. When visual hallucinations developed within the first 5 years of dementia, the odds were 4-5 times greater for autopsy-confirmed LBD (or intermediate/high likelihood dementia with Lewy bodies) and not AD or AD-ALB. In LBD, limbic but not cortical Lewy body pathology was related to an earlier onset of visual hallucinations, while limbic and cortical Lewy body pathology were associated with visual misperceptions and misidentification. Cortical neurofibrillary tangle burden was associated with an earlier onset of misidentification and misperceptions in LBD and AD, but only with earlier visual hallucinations in AD/AD-ALB. Conclusion: When visual hallucinations occur within the first 5 years of the dementia, a diagnosis of LBD was more likely than AD. Visual hallucinations in LBD were associated with limbic Lewy body pathology. Visual misperceptions and misidentification delusions were related to cortical Lewy body and neurofibrillary tangle burden in LBD and AD/AD-ALB.

KW - Alzheimer's disease

KW - Dementia with Lewy bodies

KW - Lewy body disease

UR - http://www.scopus.com/inward/record.url?scp=84873734416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873734416&partnerID=8YFLogxK

U2 - 10.1016/j.parkreldis.2012.10.013

DO - 10.1016/j.parkreldis.2012.10.013

M3 - Article

C2 - 23182311

AN - SCOPUS:84873734416

VL - 19

SP - 227

EP - 231

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

SN - 1353-8020

IS - 2

ER -