Geriatrics Gerontology & Palliative Nursing

Background: Lewy body disease (LBD) is a collective term of Parkinson’s disease (PD), PD with dementia (PDD), incidental LBD (iLBD), Lewy body dysphagia, pure psychiatric presentation (PPP) and dementia with LBD (DLB). Diagnosis of LBD has suffered from symptomatic heterogeneity because LBD has diverse clinical symptoms that are grouped into four; cognitive disturbance, psychiatric features, motor and non-motor symptoms. PPP may be the fourth subtype in which non-neurological psychiatric symptoms and cognitive disturbance lasted for many years. This study investigates how psychiatric pictures are associated with the other symptom groups in myocardial meta-iodobenzylguanidine (MIBG)-verified subjects with LBD.

 

Methods: Sixty patients (28 women and 32 men) were classified into three psychiatric pictures; depression-anxiety (Group D: 27patients), isolated visual hallucinations (GroupV: 16 patients) and psychosis (Group P: 17 patients). Fifty six cases were examined by single photon emission tomography (SPECT) study of the brains in which hypoperfusion were found in 37 cases and 19 cases showed no abnormality. After that, we determined final diagnoses; PD, PDD, DLB and PPP with the DSM-IV, the unified Parkinson’s disease rating scale (UPDRS), and Mini-mental state examination (MMSE).

 

Results: 40% of the Group D patients remained depressive without Parkinsonism and 50% had or developed PD. Most Group P patients developed PDD or DLB. Statistics provided four clusters with combinations of the clinical symptoms and SPECT study. PD-depression and PPP-depression with/without frontal hypoperfusion, PDD-psychosis with temporal hypoperfusion, and DLBvisual hallucination with occipital hypoperfusion. Thus, Group V had DLB and Group D had PD and PPP. Group P had PDD. Motor symptoms were closely associated with cognitive disturbance.

Summary of the four clusters of symptomatic homogeneity with 3D. PD-depression and PPP-depression with/without hypo-frontality, PDD-psychosis with temporal hypoperfusion, and DLB-visual hallucination with occipital hypoperfusion.  

Conclusions: PPP is a prodromal depression of PD and also preparative of iLBD. The psychotic feature and visual hallucinations, when complicated by motor symptoms, predicts following dementia. Isolated depression with non-motor symptoms is a risk for PD.

 

Recent Publications:

1. Kobayashi K, Nakano H, Akiyama N, et al: Pure psychiatric presentation of the Lewy body disease is depression-an analysis of 60 cases verified with myocardial meta-iodobenzylguanidine study. International Journal of Geriatric Psychiatry. 30:663-668, 2015.
2. Kobayashi K, Sumiya H, Nakano H, et al: Detection of Lewy body disease in patients with late-onset depression, anxiety and psychotic disorder with myocardial meta-iodobenzylguanidine scintigraphy. International Journal of Geriatric Psychiatry 25: 55-65, 2010.
3. Kobayashi K, Kitamura T, Sudo S.: Behaviors of phosphorylated microtubules-associated protein tau (tau) – A role in neuronal and glial apoptosis, white matter lesion, topographical accentuation and 14-3-3 protein expression in of neurofibrillary tangles of Alzheimer’s disease and other Tauopathies. In: Figueiredo B, Meléndez F, eds., Neuroscience Research Advances. Nova Science Publishers, NY, 1-33, 2009.
4. Kobayashi K, Sudo S, Matsubara R, et al: Subcortical neurofibrillary tangles and argyrophilic grains in a case of familial frontotemporal dementia with parkinsonism. Parkinsonism and Related Disorders 14: 513-516, 2008.
5. Kobayashi K, Hayashi M, Nakano H, et al: Correlation between astrocyte apoptosis and Alzheimer changes in gray matter lesions in Alzheimer’s disease. Journal of Alzheimer’s disease. 6: 623–632, 2004.