Objective: To characterize the demographic and treatment characteristics for the Lewy body dementia (LBD) population in Florida using a statewide clinical data research network.

Background: LBD is the second most common degenerative dementia in the United States, however information about LBD population demographics and common treatment strategies is limited.

Method: We included patients (≥40 years-old) with an ICD-9-CM 331.82 or ICD-10CM G31.83 diagnosis code associated with at least 1 encounter (January 2012-March 2018). Prevalence and age, gender, and racial/ethnic demographics were identified. Frequency of medications and provider specialties was assessed using prescription and provider information (RXCui and NPI number).

Results: 3659 individuals with a diagnosis code for LBD were identified. Among nearly 4 million patients in the clinical research database, the prevalence of LBD was 0.10%. Males accounted for 55.7% of included individuals. Of the LBD cohort, 40% were within the age group 70-80 years and 32% were in the 80-90 years group. For those 304 individuals for whom we have age at death information, the average age at death was 79.6 (range 47-96). LBD was most commonly diagnosed in individuals identifying as white (79.7%), African American/black (11.1%), Asian (1.2%) and other (8%). Almost 19% of the population identified as Hispanic. Approximately 43% of individuals with LBD received a cognitive enhancing medication during the examined period. Donepezil was most commonly prescribed (19.9%), followed by memantine (12.7%), rivastigmine (9.6%), and galantamine (<1%). These medications were most commonly prescribed by neurologists/psychiatrists (20.2%) followed by internal medicine physicians (8.6%). The most frequently prescribed anti-psychotics were quetiapine (17.4%), risperidone (5.4%), and olanzapine (3.2%). Frequency of pimavanserin (0.7%) and clozapine use (0.7%) was low. Most commonly used dopaminergic medications were levodopa (28.5%) followed by dopamine agonists (7.3%).

Conclusion: Fewer than half of individuals with LBD in this cohort received a cholinesterase inhibitor trial, a clear area to target improvement. African-Americans account for a lower percent of LBD cases than the proportion of African-Americans (17%) in Florida suggesting LBD may be underdiagnosed in this population [1]. Opportunities to improve care include diagnosis amongst racial/ethnic minorities and decreased use of inappropriate antipsychotics.

References: [1] U.S. Census Bureau QuickFacts: Florida.” Census Bureau QuickFacts, United States Census Bureau, www.census.gov/quickfacts/fl. Accessed March 1, 2019.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/patterns-of-lewy-body-dementia-diagnosis-and-treatment-in-florida/