Neuroleptic sensitivity in dementia with cortical Lewy bodies.
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Biomedical subjects
Publications and source records attributed to E J Byrne.
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Five elderly patients presenting with neuropsychiatric systemic lupus erythematosus were referred to the sectorised psychiatry service of the department of health care of the elderly. They represented 2% of patients admitted over a period of two years. Two patients presented with a subacute confusional state, two with dementia, and one with depression. Three patients responded well to treatment. This suggests that systemic lupus erythematosus (SLE) is more common in elderly people than was originally thought and is a potentially treatable cause of organic brain disorder. The absence of reports of elderly patients with SLE is likely to be due to the continued application of the American Rheumatism Association's revised 1982 classification criteria, which are inappropriate for this population.
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Diffuse Lewy body disease is an important pathological substrate of the common syndrome of parkinsonian dementia. The new technique of anti-ubiquitin immunocytochemistry has been used in a correlative quantitative neuropathological study of fifteen cases of diffuse Lewy body disease, showing that the severity of dementia is related to cortical Lewy body density, whilst subcortical abnormalities make a much less significant contribution. Cortical senile plaques also appear to be part of the pathology of diffuse Lewy body disease and should not therefore be used as an isolated diagnostic criterion for Alzheimer's disease. Diagnostic criteria for diffuse Lewy body disease are discussed.
Fifteen cases of diffuse Lewy body disease were diagnosed on pathological grounds during a single year in one health district. The range and frequency of clinical features contrast strikingly with previous reports. The majority of cases presented with classical levodopa-responsive Parkinson's disease either alone (6 cases) or with mild cognitive impairment (3 cases); the remaining 6 cases presented with cognitive impairment alone. In time almost all patients developed both dementia and Parkinsonism. The dementia was cortical in type, but unusual in that most (12 cases) showed day-to-day fluctuation in severity at some point in their illness. These findings suggest that diffuse Lewy body disease is not rare, and that it presents in a range of ways from dementia with subsequent Parkinsonism to Parkinson's disease with subsequent dementia. The latter mode of presentation suggests that it should be considered as a significant pathological substrate of dementia in Parkinson's disease.
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Using four brief assessment scales, profiles of mental health and psychological well-being were obtained from 507 old (aged 65-74 years) and 535 very old (aged 75+) individuals randomly sampled from the community. Assessments of dementia and depression were subsequently validated against diagnostic ratings made by experienced psychogeriatricians. Levels of agreement between psychometric and clinical ratings of dementia (kappa = 0.83) and depression (kappa = 0.66) were satisfactory. The old and very old groups reported similar levels of anxiety and personal disturbance, and showed a similar prevalence of depression. However, those aged 75+ showed higher levels of dementia and significantly lower levels of social involvement and morale.
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