Clinical profiles of autopsy-confirmed dementia with Lewy bodies at institutionalization: Comparison with Alzheimer's disease

Background: It has been reported that Alzheimer's disease (AD) patients with Lewy pathology have a shorter time from a given baseline to institutionalization than those with AD alone. Taking the clinical distinction between dementia with Lewy bodies (DLB) and AD into consideration, the previous findings may indicate the possibility that the clinical characteristics of DLB patients have an influence on early institutionalization. This study was carried out to clarify whether there are any differences in the symptoms that required institutionalization between patients with DLB and those with AD. Methods: Hospital records and standardized data forms completed at admission to a residential care facility were reviewed to assess the profiles in all cases with autopsy-confirmed diagnoses for correct differential diagnosis. We examined functional, cognitive and symptomatic conditions at admission to a residential care facility of 18 DLB and 35 AD patients whose diagnoses were confirmed by autopsy. The examinations were conducted using the Gottfries-Brane-Steen (GBS) scale and cognitive tests, and the results were compared between the two groups of patients. Results: Hallucinations, impaired wakefulness, disturbance of ADL and emotional disturbance, common clinical features compatible with DLB, were more frequently observed in DLB patients than in AD patients (P < 0.05). Moreover, DLB patients had higher scores on cognitive tests than did AD patients at admission to a residential care facility (P < 0.05). Conclusion: The distinctive clinical features at admission to a residential care facility may indicate that the reasons for the necessity of institutionalization are different between DLB and AD, and that the interventions specific to DLB patients and their families would be necessary to prevent or postpone institutionalization.