Department of Neurology, Brugmann University Hospital, Brussels, Belgium.
Department of Geriatrics, Brugmann University Hospital, Brussels, Belgium.
Psychogeriatrics. 2020 May;20(3):242-246. doi: 10.1111/psyg.12490. Epub 2019 Nov 28.
Dementia with Lewy bodies (DLB) is a common but underdiagnosed type of cognitive impairment and dementia. The current diagnostic criteria for research purposes have a high specificity but lack sensitivity. Moreover, patients who live alone are not always aware that they have core clinical features such as cognitive fluctuations, visual hallucinations, and parasomnia. Anxiety is a common and early manifestation in DLB.
We matched 41 DLB patients with 41 patients with Alzheimer's disease (AD) according to gender, age, and cognitive status and retrospectively analyzed their files for the presence of anxiety, depression, constipation, and the core clinical features of DLB in the documented period before diagnosis.
Anxiety, but not depression, occurred significantly more frequently in DLB than in AD (63.4% vs 26.8%). It appears up to 4-5 years before the diagnosis of DLB and is associated with depression and living at home. Anxiety in DLB was often described as intermittent panic attacks without reason or during states of delirium; it was also severe enough to require medical treatment and inpatient or outpatient psychiatric care. It was often mistaken for a psychiatric illness or a manifestation of other common forms of dementia. Anxiety in AD seemed much milder, was often related to the patient's coping with cognitive dysfunction, and was never cited as a specific reason for medical help. The concomitant presence of anxiety with at least one core clinical criterion of DLB enabled us to differentiate it from AD in our study, with a sensitivity of 63.4% but a specificity of 100%.
In all patients over 50 who present with cognitive problems and anxiety, DLB should be considered. Patients and informants should be carefully questioned regarding the presence of other typical signs and symptoms of DLB.
路易体痴呆（DLB）是一种常见但诊断不足的认知障碍和痴呆类型。目前用于研究目的的诊断标准特异性高，但敏感性不足。此外，独居的患者并不总是意识到自己存在认知波动、视幻觉和睡眠障碍等核心临床特征。焦虑是 DLB 的常见且早期表现。
我们根据性别、年龄和认知状态将 41 例 DLB 患者与 41 例阿尔茨海默病（AD）患者进行匹配，并回顾性分析他们在诊断前记录的文件中存在的焦虑、抑郁、便秘以及 DLB 的核心临床特征。
DLB 患者的焦虑发生率明显高于 AD 患者（63.4% vs. 26.8%），其出现时间可早至 DLB 诊断前 4-5 年，并与抑郁和居家生活有关。DLB 患者的焦虑常表现为间歇性无明显原因或在谵妄状态下发生的惊恐发作；严重程度足以需要医疗治疗和住院或门诊精神科护理。它常被误诊为精神疾病或其他常见形式痴呆的表现。AD 患者的焦虑似乎要轻得多，通常与患者应对认知功能障碍有关，从未被引述为寻求医疗帮助的具体原因。在我们的研究中，焦虑与 DLB 的至少一个核心临床标准同时存在，其敏感性为 63.4%，特异性为 100%。
对于所有出现认知问题和焦虑的 50 岁以上患者，都应考虑 DLB。应仔细询问患者和知情人是否存在其他典型的 DLB 体征和症状。
