Abstract.
Dementia with Lewy bodies (DLB) was first recognized as a clinicopathological entity about 20 years ago. It is the second most-common degenerative dementia after Alzheimer's disease. Clinically, DLB differs from Alzheimer's disease in that disease symptoms are prone to fluctuate and patients often suffer from visual hallucinations, while short-term memory is relatively preserved. As many as 70% of patients have parkinsonism and up to 50% are sensitive to the extrapyramidal side effects of neuroleptic drugs. About 3 million Europeans will be affected by DLB in 2020 if no cure or effective treatment is found. This article reviews the current disease concept, as well as existing problems concerning classification and delineation of DLB from other conditions with dementia. The literature on genetic findings in this complex disease is critically discussed.
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References
Kosaka K, Matsushita M, Oyanagi S, Mehraein P (1980) A cliniconeuropathological study of the "Lewy body disease". Seishin Shinkeigaku Zasshi 82:292–311
Kosaka K, Yoshimura M, Ikeda K, Budka H (1984) Diffuse type of Lewy body disease: progressive dementia with abundant cortical Lewy bodies and senile changes of varying degree--a new disease? Clin Neuropathol 3:185–192
Ince PG, Perry EK, Morris CM (1998) Dementia with Lewy bodies. A distinct non-Alzheimer dementia syndrome? Brain Pathol 8:299–324
McKeith IG (2002) Dementia with Lewy bodies. Br J Psychiatry 180:144–147
Leverenz JB, McKeith IG (2002) Dementia with Lewy bodies. Med Clin North Am 86:519–535
Harding AJ, Broe GA, Halliday GM (2002) Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe. Brain 125:391–403
Kotzbauer PT, Trojanowsk JQ, Lee VM (2001) Lewy body pathology in Alzheimer's disease. J Mol Neurosci 17:225–232
McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, Vos RA de, Wilcock GK, Jellinger KA, Perry RH (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 47:1113–1124
Calderon J, Perry RJ, Erzinclioglu SW, Berrios GE, Dening TR, Hodges JR (2001) Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer's disease. J Neurol Neurosurg Psychiatry 70:157–164
Kenny RA, Kalaria R, Ballard C (2002) Neurocardiovascular instability in cognitive impairment and dementia. Ann N Y Acad Sci 977:183–195
Ballard CG, Shaw F, Lowery K, McKeith I, Kenny R (1999) The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord 10:97–103
McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R (2000) Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 356:2031–2036
McKeith IG, Grace JB, Walker Z, Byrne EJ, Wilkinson D, Stevens T, Perry EK (2000) Rivastigmine in the treatment of dementia with Lewy bodies: preliminary findings from an open trial. Int J Geriatr Psychiatry 15:387–392
McKeith IG, Ballard CG, Harrison RW (1995) Neuroleptic sensitivity to risperidone in Lewy body dementia. Lancet 346:699
Burton EJ, Karas G, Paling SM, Barber R, Williams ED, Ballard CG, McKeith IG, Scheltens P, Barkhof F, O'Brien JT (2002) Patterns of cerebral atrophy in dementia with Lewy bodies using voxel-based morphometry. Neuroimage 17:618–630
Harding AJ, Lakay B, Halliday GM (2002) Selective hippocampal neuron loss in dementia with Lewy bodies. Ann Neurol 51:125–128
Walker Z, Costa DC, Ince P, McKeith IG, Katona CL (1999) In-vivo demonstration of dopaminergic degeneration in dementia with Lewy bodies. Lancet 354:646–647
Colloby SJ, Fenwick JD, Williams ED, Paling SM, Lobotesis K, Ballard C, McKeith I, O'Brien JT (2002) A comparison of (99m)Tc-HMPAO SPET changes in dementia with Lewy bodies and Alzheimer's disease using statistical parametric mapping. Eur J Nucl Med Mol Imaging 29:615–622
Londos E, Passant U, Gustafson L, Brun A (2001) Neuropathological correlates to clinically defined dementia with Lewy bodies. Int J Geriatr Psychiatry 16:667–679
Duda JE, Lee VM, Trojanowski JQ (2000) Neuropathology of synuclein aggregates. J Neurosci Res 61:121–127
Dickson DW (1999) Tau and synuclein and their role in neuropathology. Brain Pathol 9:657–661
Terada S, Ishizu H, Yokota O, Tsuchiya K, Nakashima H, Ishihara T, Fujita D, Ueda K, Ikeda K, Kuroda S (2003) Glial involvement in diffuse Lewy body disease. Acta Neuropathol (Berl) 105:163–169
Forster E, Lewy FH (1912) Paralysis agitans. I. Pathologische Anatomie (von F.H. Lewy). In: Lewandowsky M, Abelsdorff G (eds) Handbuch der Neurologie III. Springer, Berlin
Pollanen MS, Bergeron C, Weyer L (1992) Detergent-insoluble cortical Lewy body fibrils share epitopes with neurofilament and tau. J Neurochem 58:1953–1956
Trojanowski JQ, Lee VMY (2002) Parkinson's disease and related synucleinopathies are a new class of nervous system amyloidoses. Neurotoxicology 23:457–460
Spillantini MG, Schmidt ML, Lee VMY, Trojanowski JQ, Jakes R, Goedert M (1997) Alpha-synuclein in Lewy bodies. Nature 388:839–840
Terada S, Ishizu H, Haraguchi T, Takehisa Y, Tanabe Y, Kawai K, Kuroda S (2000) Tau-negative astrocytic star-like inclusions and coiled bodies in dementia with Lewy bodies. Acta Neuropathol (Berl) 100:464–468
Hansen LA, Masliah E, Galasko D, Terry RD (1993) Plaque-only Alzheimer's disease is usually the lewy body variant, and vice versa. J Neuropathol Exp Neurol 52:648–654
Graeber MB, Kosel S, Egensperger R, Banati RB, Muller U, Bise K, Hoff P, Moller HJ, Fujisawa K, Mehraein P (1997) Rediscovery of the case described by Alois Alzheimer in 1911: historical, histological and molecular genetic analysis. Neurogenetics 1:73–80
McKeith IG, Ince P, Jaros EB, Fairbairn A, Ballard C, Grace J, Morris CM, Perry RH (1998) What are the relations between Lewy body disease and AD? J Neural Transm [Suppl] 54:107–116
Kosaka K (1990) Diffuse Lewy body disease in Japan. J Neurol 237:197–204
Singleton AB, Wharton A, O'Brien KK, Walker MP, McKeith IG, Ballard CG, O'Brien J, Perry RH, Ince PG, Edwardson JA, Morris CM (2002) Clinical and neuropathological correlates of apolipoprotein E genotype in dementia with Lewy bodies. Dement Geriatr Cogn Disord 14:167–175
Gearing M, Lynn M, Mirra SS (1999) Neurofibrillary pathology in Alzheimer disease with Lewy bodies: two subgroups. Arch Neurol 56:203–208
Denson MA, Wszolek ZK, Pfeiffer RF, Wszolek EK, Paschall TM, McComb RD (1997) Familial parkinsonism, dementia, and Lewy body disease: study of family G. Ann Neurol 42:638–643
Ishikawa A, Takahashi H, Tanaka H, Hayashi T, Tsuji S (1997) Clinical features of familial diffuse Lewy body disease. Eur Neurol 38 [Suppl 1]:34–38
Ohara K, Takauchi S, Kokai M, Morimura Y, Nakajima T, Morita Y (1999) Familial dementia with Lewy bodies (DLB). Clin Neuropathol 18:232–239
Brett FM, Henson C, Staunton H (2002) Familial diffuse Lewy body disease, eye movement abnormalities, and distribution of pathology. Arch Neurol 59:464–467
Tsuang DW, Dalan AM, Eugenio CJ, Poorkaj P, Limprasert P, La Spada AR, Steinbart EJ, Bird TD, Leverenz JB (2002) Familial dementia with Lewy bodies: a clinical and neuropathological study of 2 families. Arch Neurol 59:1622–1630
Galvin JE, Lee SL, Perry A, Havlioglu N, McKeel DW Jr, Morris JC (2002) Familial dementia with Lewy bodies: clinicopathologic analysis of two kindreds. Neurology 59:1079–1082
Scott WK, Grubber JM, Conneally PM, Small GW, Hulette CM, Rosenberg CK, Saunders AM, Roses AD, Haines JL, Pericak-Vance MA (2000) Fine mapping of the chromosome 12 late-onset Alzheimer disease locus: potential genetic and phenotypic heterogeneity. Am J Hum Genet 66:922–932
Lippa CF, Smith TW, Saunders AM, Crook R, Pulaski-Salo D, Davies P, Hardy J, Roses AD, Dickson D (1995) Apolipoprotein E genotype and Lewy body disease. Neurology 45:97–103
Martinoli MG, Trojanowski JQ, Schmidt ML, Arnold SE, Fujiwara TM, Lee VM, Hurtig H, Julien JP, Clark C (1995) Association of apolipoprotein epsilon 4 allele and neuropathologic findings in patients with dementia. Acta Neuropathol (Berl) 90:239–243
Arai H, Higuchi S, Muramatsu T, Iwatsubo T, Sasaki H, Trojanowski JQ (1994) Apolipoprotein E gene in diffuse Lewy body disease with or without co-existing Alzheimer's disease. Lancet 344:1307
Galasko D, Saitoh T, Xia Y, Thal LJ, Katzman R, Hill LR, Hansen L (1994) The apolipoprotein E allele epsilon 4 is overrepresented in patients with the Lewy body variant of Alzheimer's disease. Neurology 44:1950–1951
Egensperger R, Bancher C, Kösel S, Jellinger K, Mehraein P, Graeber MB (1996) The apolipoprotein E epsilon 4 allele in Parkinson's disease with Alzheimer lesions. Biochem Biophys Res Commun 224:484–486
Benjamin R, Leake A, Edwardson JA, McKeith IG, Ince PG, Perry RH, Morris CM (1994) Apolipoprotein E genes in Lewy body and Parkinson's disease. Lancet 343:1565
Armstrong M, Daly AK, Cholerton S, Bateman DN, Idle JR (1992) Mutant debrisoquine hydroxylation genes in Parkinson's disease. Lancet 339:1017–1018
Kosel S, Lucking CB, Egensperger R, Mehraein P, Graeber MB (1996) Mitochondrial NADH dehydrogenase and CYP2D6 genotypes in Lewy body parkinsonism. J Neurosci Res 44:174–183
Saitoh T, Xia Y, Chen X, Masliah E, Galasko D, Shults C, Thal LJ, Hansen LA, Katzman R (1995) The CYP2D6B mutant allele is overrepresented in the Lewy body variant of Alzheimer's disease. Ann Neurol 37:110–112
Bordet R, Broly F, Destee A, Libersa C (1994) Genetic polymorphism of cytochrome P450 2D6 in idiopathic Parkinson disease and diffuse Lewy body disease. Clin Neuropharmacol 17:484–488
Atkinson A, Singleton AB, Steward A, Ince PG, Perry RH, McKeith IG, Fairbairn AF, Edwardson JA, Daly AK, Morris CM (1999) CYP2D6 is associated with Parkinson's disease but not with dementia with Lewy bodies or Alzheimer's disease. Pharmacogenetics 9: 31–35
Furuno T, Kawanishi C, Iseki E, Onishi H, Sugiyama N, Suzuki K, Kosaka K (2001) No evidence of an association between CYP2D6 polymorphisms among Japanese and dementia with Lewy bodies. Psychiatry Clin Neurosci 55:89–92
Koide T, Ohtake H, Nakajima T, Furukawa H, Sakai K, Kamei H, Makifuchi T, Fukuhara N (2002) A patient with dementia with Lewy bodies and codon 232 mutation of PRNP. Neurology 59:1619–1621
Pompeu F, Growdon JH (2002) Diagnosing dementia with Lewy bodies. Arch Neurol 59:29–30
Lopez OL, Becker JT, Kaufer DI, Hamilton RL, Sweet RA, Klunk W, DeKosky ST (2002) Research evaluation and prospective diagnosis of dementia with Lewy bodies. Arch Neurol 59:43–46
Hishikawa N, Hashizume Y, Yoshida M, Sobue G (2003) Clinical and neuropathological correlates of Lewy body disease. Acta Neuropathol (Berl) 105:341–350
Acknowledgements.
The authors would like to thank Dr. Chris M. Morris, Newcastle, UK, for valuable comments on the manuscript and Dr. John Q. Trojanowski, Philadelphia, Pennsylvania, USA, for providing the alpha-synuclein-specific monoclonal antibody, LB 509. We are grateful to Ms. Louisa Djerbib of the UK Parkinsons' Disease Society Tissue Bank at Imperial College London for carrying out the immunocytochemical staining.
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Graeber, M.B., Müller, U. Dementia with Lewy bodies: disease concept and genetics. Neurogenetics 4, 157–162 (2003). https://doi.org/10.1007/s10048-003-0155-y
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DOI: https://doi.org/10.1007/s10048-003-0155-y