Objective: To examine which neuropsychological characteristics are associated with cognitive fluctuations (CF) in patients with dementia with Lewy bodies (DLB).

Background: СF are core diagnostic feature of DLB, the second most common dementia in the elderly. However, correlation of CF with other neuropsychological symptoms of the disease are not well understood.

Method: 80 DLB patients, 76±5,32 years old; 2,3±0,72 years disease duration, underwent clinical evaluation including Mini-Mental State Examination (MMSE) , Neuropsychiatric Inventory (NPI) questionnaire, Clock Drawing Test, Semantic and Phological Verbal Fluency to estimate global cognition, visual attention, verbal and non-verbal memory, executive functions, visuospatial and visuoconstructive skills, verbal fluency and neuropsychiatric symptoms. CF was diagnosed according Mayo Fluctuations Questionnaire administered to the informant.

Results: Out of the 80 patients, 42,5% had CF. The presence of CF was associated with longer disease duration (2,4±0,757 versus 1,9±0,34, p<0,01) but not with age or educational level. Cognitive correlates of CF were deficits in attention (digit span forward:p<0,05) and phological verbal fluency (p<0.05) on a background of a slightly worse global cognitive performance (Mini-Mental State Examination: p<0.05). Patients with CF had significantly pronounced apathy and visual hallucinations (Neuropsychiatric Inventory (NPI) questionnaire:p<0.05).

Conclusion: The results of this study suggest that presence of CF in DLB associated with more pronounced cognitive decline predominantly due to attention disturbance, more severe apathy and visual hallucinations. This findings may be related to more severe dopamine and acetylcholine imbalance in patient with CF. Additional research using larger samples and more sensitive neuropsychological tools, preferably accompanied by functional neuroimaging are needed.

References: 1. Armstrong, M. J. (2019). Lewy body dementias. CONTINUUM: Lifelong Learning in Neurology, 25(1), 128-146.1.
2. O’Dowd, S., Schumacher, J., Burn, D. J., Bonanni, L., Onofrj, M., Thomas, A., & Taylor, J. P. (2019). Fluctuating cognition in the Lewy body dementias. Brain, 142(11), 3338-3
3. Van Dyk, K., Towns, S., Tatarina, O., Yeung, P., Dorrejo, J., Zahodne, L. B., & Stern, Y. (2016). Assessing fluctuating cognition in dementia diagnosis: interrater reliability of the clinician assessment of fluctuation. American Journal of Alzheimer’s Disease & Other Dementias®, 31(2), 137-143.2.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychological-correlates-of-cognitive-fluctuations-in-dementia-with-lewy-bodies/