The Neuropsychiatric Symptom Profile of Mild Dementia With Lewy Bodies

Abstract

Introduction

Neuropsychiatric symptoms are often considered late manifestations of dementia and can be neglected during early clinical assessments. Besides visual hallucinations, less is known about other neuropsychiatric symptoms in mild dementia with Lewy bodies (DLB). We aimed to 1) describe neuropsychiatric symptoms and associated caregiver distress in mild DLB; 2) describe neuropsychiatric symptoms stratified by dementia stage within the included participants.

Methods

Individuals with probable DLB and their caregivers underwent clinical and neuropsychiatric assessments. Clinical Dementia Rating Global Score (CDR-G) of 0.5 (denoting “very mild dementia”) was used to stratify the participants into earlier and later stage subgroups. The Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms. Median regression was used to estimate the difference in symptom severity and caregiver distress between the subgroups.

Results

Fifty participants (age 73.5 ± 5.7 years, 43 males, median mini mental state exam (MMSE) 26 [IQR 23 - 27], median CDR 0.5 [IQR 0.5 - 1]) were enrolled. Twenty-six had earlier and 24, later stage dementia. Neuropsychiatric symptoms were common across both subgroups (96.2% and 95.8% prevalence respectively), with apathy, anxiety and depression being most prevalent (≥50% prevalence). Overall symptom severity was similar between the subgroups, although caregivers of the later stage subgroup reported more distress.

Conclusion

Neuropsychiatric symptom, especially apathy, anxiety and depression, are extremely common in mild DLB. Assessment of neuropsychiatric symptoms is therefore an essential part of clinical care in DLB, starting from initial presentation. Future studies should consider factors other than symptom severity that contribute to caregiver distress.

Plain Language Summary

Behavioural and psychological symptoms (for example agitation or depression) commonly affect individuals with dementia with Lewy bodies (DLB), although often these symtpoms are neglected during the first few doctor visits, when the disease is mild, in favour of cognitive symptoms. A lot is already known about visual hallucinations (seeing things that are not really there) in mild DLB, however, less is known about the other behavioural and psychological symptoms that also occur. In this study, we used a caregiver questionnaire to examine twelve different behavioural and psychological symptoms in a group of 50 participants (43 men, 7 women) with mild DLB, as well as the distress each symptom caused their caregivers. We then further split these participants into “earlier” (26 participants) and “later” (24 participants) disease groups to see if there was a difference in their symptoms. The symptoms we inquired about were delusions (believing something is true when it is not), hallucinations, agitation/aggression, depression, anxiety, elation (being unusually happy), apathy (lacking in motivation), disinhibition (loss of restraint), irritability/lability (easily changeable emotions), aberrant motor behaviour (pacing, picking at things), sleep disturbances and appetite disturbances. We found that these symptoms were extremely common (affecting more than 95%) in this group of mild DLB, across both “earlier” and “later” disease group, especially apathy, anxiety and depression (affecting more than 50%). The earlier and later disease groups had similar overall symptom severity, although caregivers of the later disease group were more distressed by these symptoms. These results suggest that clinicians should also inquire about behavioural and psychological symptoms from when patients first attend clinic so that they can be addressed at the earliest possible stage. Similarly, patients and families should be aware that symptoms unrelated to cognition often occur in mild DLB.