Objective: To investigate if White matter hyperintensities (WMHs), neuropsychiatric symptoms and cognitive performance associate with, and/or predict activities of daily living (ADLs) differently in Alzheimer’s disease (AD) or Dementia with Lewy Bodies (DLB).

Background:
Loss of functional independence is common across DLB and AD. WMHs are prevalent in both diagnoses and associate with disability, and both diagnoses show neuropsychiatric symptoms and impaired cognition.

Method: We examined if WMHs, neuropsychiatric symptoms, and cognitive domains associate with Basic and/or Instrumental ADLs (BADL and IADL) cross-sectionally (n=263. AD=214; DLB=49), and longitudinally (n=154. AD=129; DLB=25) over ~1.4 years, using multiple linear regression with backward stepwise selection. All patients underwent volumetric MRI for total WMH quantification, and ADL (Disability Assessment for Dementia scale), neuropsychiatric (Neuropsychiatric inventory-NPI), and cognitive (comprehensive test battery) assessment at baseline. ADLs were reassessed after 1.4 years.

Results: DLB patients were younger, had better global cognition and lower WMH volume, but higher neuropsychiatric symptoms and disability at baseline than AD. Across both diagnostic groups, NPI was not only associated with greater disability in performing both BADL [AD: difference(β):-0.29(95%CI:-0.39, -0.20); DLB difference(β): -0.28 (95%CI:-0.51,-0.04)] and IADL [AD: difference(β):-0.91(95%CI:-1.14,-0.68);DLB difference(β):-0.72(95%CI:-1.04,-0.40), but was associated with a decline in the ability to perform BADL in the AD group as well [decline(β):-0.36(95%CI:-0.56,-0.15)]. Higher WMH volume was associated with greater disability in performing both BADL [difference per SD(β):-7.51(95% CI:-11.69,-3.32)] and IADL [difference per SD(β):-7.47(95%CI:-13.28,-1.66)] in the DLB group only, and was also associated with a decline in the ability to perform BADL [decline per SD(β):-11.09(95%CI:-21.90,-0.28)] in this group over time.

Conclusion:
Neuropsychiatric symptoms were important determinants of both basic and instrumental functionality across AD and DLB. Despite the lower burden of WMHs in DLB than AD, WMH volume predicted functionality in the DLB group only. WMHs might interact with DLB pathology differently than with AD pathology consequently influencing functional performance.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-white-matter-hyperintensities-neuropsychiatric-symptoms-and-cognition-on-activities-of-daily-living-differences-between-dementia-with-lewy-bodies-and-alzheimers-disease/