Background Dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) are recognised to be under-recognised in clinical practice in the UK, with only one third to a half of expected cases diagnosed. We aimed to assess whether clinical diagnostic rates could be increased by the introduction of a structured assessment toolkit for clinicians. Methods We established baseline diagnostic rates for DLB and PDD in four memory clinics and three movement disorder/Parkinson’s disease (PD) clinics in two separate geographical regions in the UK. An assessment toolkit specifically developed to assist with the recognition and diagnosis of DLB and PDD was then introduced to the same clinical teams and diagnostic rates for DLB and PDD were reassessed. For assessing DLB diagnosis, a total of 3820 case notes were reviewed before the introduction of the toolkit, and 2061 case notes reviewed after its introduction. For PDD diagnosis, a total of 1797 case notes were reviewed before the introduction of the toolkit and 3405 case notes after it. Mean values and proportions were analysed using Student’s t test for independent samples and χ 2 test, respectively. Results DLB was diagnosed in 4.6% of dementia cases prior to the introduction of the toolkit, and 6.2% of dementia cases afterwards, an absolute rise of 1.6%, equal to a 35% increase in the number of DLB cases diagnosed when using the toolkit ( χ 2 = 4.2, P = 0.041). The number of PD patients diagnosed with PDD was not found overall to be significantly different when using the toolkit: 9.6% of PD cases before and 8.2% of cases after its introduction ( χ 2 = 1.8, P = 0.18), though the ages of PD patients assessed after the toolkit’s introduction were lower (73.9 years vs 80.0 years, t = 19.2, p < 0.001). Conclusion Introduction of the assessment toolkit was associated with a significant increase in the rate of DLB diagnosis, suggesting that a structured means of assessing symptoms and clinical features associated with DLB can assist clinicians in recognising cases. The assessment toolkit did not alter the overall rate of PDD diagnosis, suggesting that alternate means may be required to improve the rate of diagnosis of dementia in Parkinson’s disease.

AbstractBackgroundUsing the UK's Brains for Dementia Research (BDR) program, we investigated the frequency of neuropathological dementia diagnosis, the proportion of pure, mixed or concomitant pathologies and the pathological substrates for cognitive impairment.MethodAll cases (n = 673) underwent standardised neuropathological assessment outlined in [1]. Cases were classed as ‘pure’, ‘mixed’ or ‘concomitant’. 473 cases had clinical dementia rating (CDR) scores: binary linear regression was employed to estimate the odds of increasing CDR score due to the presence of pathologies and multiple pathologies.Result142 cases (21.1%) were diagnosed as controls and 531 fulfilled the criteria for a neurodegenerative disease: Alzheimer’s disease (n = 221) > Lewy body disease (n = 65) > vascular dementia (n = 50). Only 23.5% were classified as ‘pure’, 63.1% as ‘concomitant’ and 13.4% as ‘mixed’. 147 (28.9%) had no cognitive impairment and 301 had dementia. Higher burdens of hyperphosphorylated‐ τ (Hpτ), amyloid‐β and α‐synuclein burden had a three‐fold increase on the risk of being demented (OR = <3.4; 95% CI 2.1, 5.5). Regarding the conversion from mild cognitive impairment to dementia, Hpτ had a two‐fold increase on risk (OR = 1.75; 95% CI 1.16, 2.6) and the presence of multiple pathologies had a nine‐fold increase on risk (OR = 8.8; 95% CI 3.19, 24.3).ConclusionThe majority of the BDR cohort contains multiple pathologies. Increasing burden of Hpτ and multiple pathologies greatly increases the odds of dementia. (1) Francis et al, (2018) DOI 10.3233/JAD‐180699.

Objective: To compare Neuropsychiatric symptoms (NPS) in participants with Parkinson’s disease (PD), Parkinson’s disease with dementia (PDD), dementia with Lewy bodies (DLB), Alzheimer’s disease (AD) and healthy older adults (HOA). Background: Neuropsychiatric symptoms (NPSs) are common in neurodegenerative diseases and present differently depending on the disease type. Identification of specific NPS profiles could be useful for clinical management or identifying individuals at risk of developing dementia subtypes. Method: A cross-sectional sample (n=187) of participants with PD, PDD, DLB, or AD were compared with HOA; participants were from the ICICLE-PD and GaitDem studies. NPS were evaluated using the Neuropsychiatric Inventory (NPI), a comprehensive assessment answered by the participant’s caregiver which scores the frequency and severity of twelve common NPS, plus a total score. Backwards stepwise linear regression was used to identify which NPS symptoms were associated with NPI total. Results: The most commonly reported symptoms were apathy in AD participants (53.6%), anxiety in DLB participants (65.4%), depression for PDD participants (55.8%), and sleep disturbances for PD participants (36.2%). There were no significant differences in NPI total score across dementia groups, although hallucinations were more frequent in PDD and DLB (p<0.001) and anxiety was more frequent in DLB (p<0.001). Regression analysis yielded four distinct NPS profiles across PD, PDD, DLB, and AD groups. The models accounted for 76.2-82.7% of the NPS variance (p<0.001 for all). Conclusion: NPS are more common and more severe in neurodegenerative disorders compared with normal ageing. The profile of NPS associated with a greater overall psychiatric burden is unique to each disorder group. Future work should investigate how these profiles change as the disease advances. Identification of NPS profiles could identify individuals most at risk of developing dementia, support differential diagnosis, and could have utility in future clinical trials.

Objective: To evaluate the change in gait and minimum toe clearance when walking under dual task in different dementia sub-types as a contributor to dynamic falls risk. Background: Dementia is one of the most common neurodegenerative disorders in older adults affecting 46.8 million people worldwide [1]. Recurrent falls are common in people with Alzheimer’s disease (AD; 26%), Dementia with Lewy Bodies (DLB; 40%) and Parkinson’s disease dementia (PDD; 73%)[2]. A reduced minimum toe clearance (MTC) may contribute to dynamic falls risk and may be further exacerbated when cognitive resources are challenged. Methods: Four groups were assessed: AD (n=30), DLB (n=15), PDD (n=10) and controls (n=28). Participants performed 6 x 10m walks under single (ST) and dual (DT; maximal digit span) task conditions. Temporal spatial gait characteristics were measured using an instrumented walkway and MTC was quantified using 3D motion capture. DT cost was calculated ((ST – DT)/ST)*100. Differences in gait and MTC due to task and group were evaluated using a General Linear Model controlling for sex. Results: Falls prevalence in the patient groups was 33% in AD, 60% in DLB and 80% in PDD. There were no significant differences in gait or MTC between the DLB and PDD groups during ST or DT so the groups were collapsed (Lewy body disease; LBD n=25). Participants walked slower, with a shorter step length, increased stance time, wider step and a lower MTC during DT (p<.007). Similarly, a lower MTC was observed during DT irrespective of group (p=.027). Significant differences in gait and MTC were highlighted between controls and both patient groups (p<.05) but not between patient groups (AD vs. LBD) [Figure 1]. Further investigation of MTC [Figure 1] revealed that the largest DT cost in MTC was observed in the PDD group (~12%) compared to AD (~2%) and DLB (~4%) however this difference was not significant. Conclusions: Over short intermittent walks, AD and DLB groups presented with comparable temporal-spatial gait and MTC and this was not influenced by the addition of a dual task. Gait deficits were evident in dementia groups irrespective of cognitive challenge. MTC deficits are exacerbated under DT in PDD and this may contribute in part to the increased falls prevalence in PDD compared to other dementia sub-types reflecting the dynamic nature of fall risk factors.