Objective: To describe the clinical phenotype of the subgroup of patients with Dementia with Lewy bodies (DLB) followed in a movement disorder setting rather than in a memory clinic

Background: The clinical diagnosis of Lewy body dementia is still difficult with the clinical and neuropathological overlap to Parkinson’s dementia on one side and Alzheimer’s disease on the other side

Method: The study is a retrospective review of the medical records of 79 patients diagnosed with DLB and followed in a tertiary movement disorder clinic at Copenhagen University Hospital Bispebjerg, Denmark between April 2018 and January 2023 focusing primarily on the parkinsonian and autonomic features

Results: The mean age at diagnosis was 75 years (range 52 – 90). 25% of the patients were female. The mean disease duration at the time of diagnosis was 3.3 years (range 0 – 8) and 32% of the patients had previously been diagnosed with Parkinson’s disease (PD). 54% of patients had cognitive symptoms as the first symptom, 18% had parkinsonism, and 29% described a combination of cognitive symptoms and parkinsonism at the onset. 

Of the 77 patients with parkinsonism, the distribution was symmetrical at diagnosis in 36% of patients and in 49% of the patients rest tremor was observed. In most patients, the parkinsonian features were discrete with a mean H&Y score of 1.8 (range 0 – 4) at diagnosis. Results of a DAT-SPECT showed symmetrically reduced binding in 68%. 89% of the patients were treated with levodopa at some point in the disease course with a mean maximum tolerated dose of 280 mg (range 50 – 600). 78% of the treated patients experienced some kind of levodopa response.

In all patients, at least one autonomic feature was present during the disease course and 34% needed medical treatment for orthostatism. 78,4% had RBD at diagnosis, and in 25% the RDB symptoms were present before the onset of cognitive or motor symptoms.

Conclusion: The parkinsonian features of DLB does not differ significantly from PD and levodopa response, asymmetrical distribution, and rest tremor are common, although DAT-SPECT showed symmetrical reduced binding in two thirds of the patients. A majority of patients had RBD and all patients included in this study had at least one autonomic dysfunction. In order to increase the diagnostic accuracy of DLB, we suggest focused interview with caregiver regarding cognitive symptoms and RBD early in the disease course

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characteristics-of-patients-with-dementia-with-lewy-bodies-followed-in-a-movement-disorder-clinic/