Objective: To examine if Lewy Body dementia (LBD) clinical diagnostic criteria will be less accurate for detecting Lewy Body Disease (the pathological diagnosis) in the oldest-old than reports in younger ages due to the concurrence of other neuropathological changes.

Background: LBD is an umbrella term for Parkinson’s Disease Dementia and Dementia with Lewy Bodies [1] and is associated with cognitive, motor, and autonomic dysfunctions [2]. The Oldest-old (ages >90) are the fastest growing segment of the population and have the highest rates of dementia [3]. Therefore, accurate diagnosis of LBD in the oldest-old is key to minimizing its impact on healthcare. However, the presence of multiple neuropathological changes is more common in the oldest-old [4] which may obscure the clinical features of LBD [5].

Method: Participants were from the 90+ Study, a prospective study of aging and dementia in the oldest-old, WE analyzed the volunteer subset (not part of the Leisure World Cohort study [6]) (figure 1) as they represent a contemporary population who were assessed following the National Alzheimer’s Coordinating Center (NACC) Neuropathology form version 10 or higher. Clinical diagnoses via consensus case conference followed current guidelines for LBD [7-8]. Neuropathological assessments were performed using standard guidelines [9]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical diagnoses for the detection of a neuropathological diagnosis of Lewy Body disease were calculated.

Results: For the 152 participants, the mean age was 97, 59% were female and 57% had > college education (table 1). 3% received a clinical diagnosis of LBD and 14% had a neuropathological diagnosis of Lewy Body disease, yielding a 19% sensitivity, 99% specificity, 80% PPV, and 88% NPV (table 2).

Conclusion: Clinical diagnostic criteria had a lower sensitivity for detection of Lewy Body disease in the oldest-old than in younger ages (19% vs. 73%), but retained high specificities (99% vs. 93%), PPV (80% vs. 79%), and NPV (90% vs. 88%) [10].

Figure 1

Table 1

Table 2

References: 1. Armstrong MJ. Advances in dementia with Lewy bodies. Ther Adv Neurol Disord. 2021;14:17562864211057666. Published 2021 Nov 23. doi:10.1177/17562864211057666
2. Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia. Lancet Neurol. 2020;19(2):157-169. doi:10.1016/S1474-4422(19)30153-X
3. Kawas CH, Legdeur N, Corrada MM. What have we learned from cognition in the oldest-old. Curr Opin Neurol. 2021;34(2):258-265. doi:10.1097/WCO.0000000000000910
4. Kawas CH, Kim RC, Sonnen JA, Bullain SS, Trieu T, Corrada MM. Multiple pathologies are common and related to dementia in the oldest-old: The 90+ Study. Neurology. 2015;85(6):535-542. doi:10.1212/WNL.0000000000001831
5. Coughlin D, Xie SX, Liang M, et al. Cognitive and Pathological Influences of Tau Pathology in Lewy Body Disorders. Ann Neurol. 2019;85(2):259-271. doi:10.1002/ana.25392
6. Melikyan ZA, Greenia DE, Corrada MM, Hester MM, Kawas CH, Grill JD. Recruiting the Oldest-old for Clinical Research. Alzheimer Dis Assoc Disord. 2019;33(2):160-162. doi:10.1097/WAD.0000000000000260
7. Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591-1601. doi:10.1002/mds.26424
8. McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89(1):88-100. doi:10.1212/WNL.0000000000004058
9. Montine TJ, Phelps CH, Beach TG, et al. National Institute on Aging-Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach. Acta Neuropathol. 2012;123(1):1-11. doi:10.1007/s00401-011-0910-3
10. Skogseth R, Hortobágyi T, Soennesyn H, et al. Accuracy of Clinical Diagnosis of Dementia with Lewy Bodies versus Neuropathology. J Alzheimers Dis. 2017;59(4):1139-1152. doi:10.3233/JAD-170274

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessing-the-accuracy-of-clinical-diagnostic-criteria-of-lewy-body-dementia-for-detection-of-lewy-body-disease-in-the-oldest-old-the-90-study/