The spectrum ofpathologic diagnoses in patients presenting with dementia who subsequently develop parkinsonism is incompletely defined. To address this issue, we examined the brains from 19 patients with symptomatic parkinsonism within a year of their initial evaluation for dementia. Eighteen patients met CERAD pathologic criteria for Alzheimer k disease (AD), 14 of these hadpure AD and four had AD with concurrent cortical Lewy bodies (CLB). Only one case had dementia with Lewy bodies (DLB) without AD changes. Wefound no clinicalfeatures that could distinguish pure AD patientsfrom patients with CLB with certainty however the presence of disordered ideation increased the likelihood of DLB. We conclude that patients who present with dementia and subsequently develop parkinsonism frequently have AD if other signs of DLB are absent.
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References
1.
1. Lennox G, Lowe R, Morrell R, et al: Anti-ubiquitin immunochemistry is more sensitive than conventional techniques in the detection of diffuse Lewy body disease. Neurol Neurosurg Psychiatry. 1989; 52: 67-71.
2.
2. McKeith IG, Galasko D, Kosaka K, et al: Consensus guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies: Report of the Consortium on DLB International Workshop. Neurology. 1996; 46: 1113-1124.
3.
3. Ball MJ: Neuronal loss, neurofibrillary tangles and granulovacuolar degeneration in the hippocampus with ageing and dementia a quantitative study. Acta Neuropathol (Berl). 1977; 37: 111-118.
4.
4. Terry RD, Peck A, De Teresa R, et al: Some morphometric aspects of the brain in senile dementia of the Alzheimer's type. Anti Neurology. 1981; 10: 184-192.
5.
5. Whitehouse PJ, Price DL, Struble RG, et al: Alzheimer's disease and senile dementia: Loss of neurons in the basal forebrain. Science. 1982; 215: 1237-1239.
6.
6. Hyman BT, Van Hoesen GW, Kromer BA, et al: Perforant pathway changes and the memory impairment of Alzheimer's disease. Ann Neurol. 1986; 20: 472-481.
7.
7. Terry R, Masliah E, Salmon DP, et al: Physical basis of cognitive alterations in Alzheimer's disease: Synapse loss is the major correlate of cognitive impairment. Ann Neurol. 1991; 30: 572-580.
8.
8. Perry RH, Irving D, Blessed G, et al: Senile dementia of Lewy body type. A clinically and neuropathologically distinct type of Lewy body dementia in the elderly. JNeurol Sci.1990; 95: 119-139.
9.
9. Gibb WRG, Esiri MM, Lees AJ: Clinical and pathological features of diffuse cortical Lewy body disease (Lewy body dementia). Brain. 1987; 110: 1131-1153.
10.
10. Dickson DW. Ruan D, Crystal H, et al: Hippocampal degeneration differentiates diffuse Lewy body disease (DLBD) from Alzheimer's disease: Light and electron microscopic immunocytochemistry of CA2-3 neurites specific to DLBD. Neurology. 1991; 41: 1402-1409.
11.
11. Mirra SS, Heyman A, McKeel D, et al: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology. 1991; 41: 479-486.
12.
12. Braak H. Braak E. Staging of Alzheimer's disease-related neurofibrillary changes. NeurobiolAging. 1995; 16: 271-284.
13.
13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders IV. American Psychiatric Association, Washington DC1994.
14.
14. Campbell SK, Switzer RC, Martin TL: Alzheimer's plaques and tangles. A controlled and enhanced silver staining method [abstract]. Soc Neurosci Abstr. 1987; 13: 678-678.
15.
15. Shi S, Key ME, Kalra KL: Antigen retrieval in formalin-fixed, paraffin embedded tissues: An enhancement method for immunohistochemical staining based on microwave oven heating of tissue sections. JHistochem Cytochem. 1991; 39: 741-748.
17. Sherrington R, Rogaev El, Liang Y, et al: Cloning of a gene bearing missense mutations in early-onset familial Alzheimer's disease. Nature. 1995; 375: 754-760.
18.
18. Hansen L, Salmon D, Galasko D, et al: The Lewy body variant of Alzheimer's disease: A clinical and pathological entity. Neurolog. 1990; 40: 1-8.
19.
19. Byrne EJ, Lennox G, Lowe J, et al: Diffuse Lewy body disease: Clinical features in 15 cases. JNeurol Neurosurg Psvchiatry. 1989; 52: 709-717.
20.
20. Filley CM: Neuropsychiatric features of Lewy body disease. Brain and Cogn.1995; 28: 229-239.
21.
21. Salmon DP, Galasko D, Hansen LA, et al: Neuropsychological deficits associated with diffuse Lewy body disease. Brain and Cogn.1996; 31: 148-165.
22.
22. Byrne EJ, Lennox GG, Lowe J, et al: Diffuse Lewy body disease: the clinical features. Advances in Neurology, Vol 53. Parkinson's disease. Anatomky, Pathology and therapy, edited by MB Streifler, AD Korczyn, E Melamed and MBH Youdim. Ravin Press, New York1990; 283-296.
24. Crystal HA, Dickson DW, Lizardi JE, et al: Antemortem diagnosis of diffuse Lewy body disease. Neurology. 1990; 40: 1523-1528.
25.
25. McKeith IG, Fairbairn AF, Perry R, et al: Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ. 1992; 305: 673-678.
26.
26. McKeith IG, Fairbairn AF, Bothwell RA, et al: Operational criteria for senile dementia of the Lewy body type. Psychol Med.1982; 22: 911-922.
27.
27. Lippa CF, Pulaski-Salo D, Dickson DW, et al: Alzheimer's disease, Lewy body disease and aging: A comparative study of the perforant pathway. JNeurol Sci.1997; 147: 161-166.
28.
28. Lippa CF, Smith TW, Nee L, et al: Familial Alzheimer's disease and cortical Lewy bodies: Is there a genetic susceptibility factor?Dementia. 1995; 6: 97-103.
29.
29. Morris JC, Drazner M, Fulling K, et al: Clinical and pathological aspects of parkinsonism in Alzheimer's disease: A role for extranigral factors?Arch Neurol. 1989; 39: 1159-1165.
30.
30. Liu Y, Stern Y, Chun MR, et al: Pathological correlates of extrapyramidal signs in Alzheimer's disease. Ann Neurol. 1997; 41: 368-374.
31.
31. Hohl U, Corey-Bloom J, Hansen LA, et al: Diagnostic accuracy of dementia with Lewy bodies: A prospective study. Neurology. 1997; 48 [Suppl]: AI0I. 235-235
