Abstract
The aim of this study was to verify if visual hallucinations and extrapyramidal signs are associated with a high speed of cognitive decline in degenerative dementia patients with amnesic onset. The analysis of 1082 consecutive patients showed that hallucinations, but not extrapyramidal signs, were associated with a faster cognitive decline. However, patients with hallucinations were also more severe at the time of examination with the Milan Overall Dementia Assessment (MODA). One interpretation is that hallucinations are the marker of a distinct process of nervous degeneration that specifically causes a steeper cognitive decline from onset. Another interpretation is that the speed of cognitive decline is set along a continuum, and the incidence of hallucinations is simply proportional to the level of cognitive decline. The statistical analysis of our data was consistent with the latter interpretation, in that we were able to quantify the probability of presenting visual hallucinations on the basis of the overall severity of cognitive decline.
Sommario
Lo scopo del presente studio è stato quello di verificare se la presenza di allucinazioni visive e di segni neurologici extrapiramidali fosse associato con una maggior rapidità di progressione del declino cognitivo in pazienti affetti da demenza ad esordio amnesico. L’analisi condotta su 1082 pazienti consecutivi ha mostrato che solo le allucinazioni visive e non i segni extrapiramidali sono correlati ad un decorso più rapido del declino cognitivo. Va segnalato che i pazienti con allucinazioni visive erano anche i pazienti più compromessi allorché valutati con il test di screening MODA (Milan Overall Dementia Assessment). Una possibile interpretazione è che le allucinazioni siano un epifenomeno distintivo di un particolare processo degenerativo, responsabile di un decorso del declino cognitivo più rapido. Un’altra interpretazione è che la rapidità del declino cognitivo si distribuisca secondo un continuum e che l’incidenza delle allucinazioni visive sia semplicemente proporzionale alla severità del profilo cognitivo. Dall’analisi statistica condotta quest ultima appare l’interpretazione più convincente, data la possibilità di stimare agevolmente la probabilità di presentazione delle allucinazioni visive sulla base della gravità del profilo cognitivo globale del paziente.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Reference
Mayeux R, Stern Y, Spanton S (1985) Heterogeneity in dementia of the Alzheimer type: evidence of subgroups. Neurology 35:453–461
Olichney JM, Galasko D, Salmon D et al (1998) Cognitive decline is faster in Lewy body variant than in Alzheimer’s disease. Neurology 51:351–357
Ballard C, Patel A, Oyebode F, Wilcock G (1996) Cognitive decline in patients with Alzheimer’s disease, vascular dementia and senile dementia of Lewy body type. Age Ageing 25:209–213
Armstrong TP, Hansen LA, Salmon DP et al (1991) Rapidly progressive dementia in a patient with the Lewy body variant of Alzheimer’s disease. Neurology 41:1178–1180
Ballard C, Holmes C, McKeith I et al (1999) Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer’s disease. Am J Psychiatry 156:1039–1045
Gomez-Isla T, Growdon WB, McNamara M et al (1999) Clinicopathologic correlates in temporal cortex in dementia with Lewy bodies. Neurology 53:2003–2009
Helmes E, Bowler JV, Merskey H et al (2003) Rates of cognitive decline in Alzheimer’s disease and dementia with Lewy bodies. Dement Geriatr Cogn Disord 15:67–71
Lopez OL, Wisniewski S, Hamilton RL et al (2000) Predictors of progression in patients with AD and Lewy bodies. Neurology 54:1774–1779
Doody RS, Massman P, Dunn JK (2001) A method for estimating progression rates in Alzheimer’s disease. Arch Neurol 58:449–454
Capitani E, Cazzaniga R, Francescani A, Spinnler H (2004) Cognitive deterioration in Alzheimer’s disease: is the early course predictive of the later stages? Neurol Sci 25:198–204
Folstein MF, Folstein SE, McHugh PR (1975) “Mini Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 12:189–198
Brazzelli M, Capitani E, Della Sala S et al (1994) A neuropsychological instrument adding to the description of patients suspected of dementia: the “Milan Overall Dementia Assessment”. J Neurol Neurosurg Psychiatry 57:1510–1517
Watson JS, Matsuyama SS, Dirham PM (1987) Relatives’ description of changes in symptoms of dementia of the Alzheimer type: a comparison of retrospective and concurrent ratings. Alzheimer Dis Assoc Disord 1:98–102
Brun A, Englund R, Gustafson L et al (1994) Clinical and neuropathological criteria for frontotemporal dementia. J Neurol Neurosurg Psychiatry 57:416–418
Roman GC, Tatemichi TK, Erkinjutti T et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260
Petersen RC, Smith GE, Waring SC et al (1999) Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 56:303–308
Litvan I, Agid Y, Calne D et al (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47:1–9
Gibb WRG, Luthert PJ, Marsden CD (1989) Corticobasal degeneration. Brain 112:1171–1192
Salmon P, Thal LJ, Butters N, Heindel WC (1990) Longitudinal evaluation of dementia of the Alzheimer type: a comparison of three standardized mental status examination. Neurology 40:1225–1230
Brooks JO, Kraemer HC, Tanke ED, Yesavage JA (1993) The methodology of studying decline in Alzheimer’s disease. J Am Geriatr Soc 41:623–628
Fillenbaum GG, Wilkinson WE, Welsh KA, Mohs RC (1994) Discrimination between stages of Alzheimer’s disease with subsets of mini-mental state examination items. Arch Neurol 51:916–921
Mendiondo MS, Ashford JW, Kryscio RJ, Schmitt FA (2000) Modelling Mini Mental Stage Examination changes in Alzheimer’s disease. Stat Med 19:1607–1616
Tiraboschi P, Salmon DP, Lawrence AH et al (2006) What best differentiates Lewy body from Alzheimer’s disease in early-stage dementia? Brain 129:729–735
Burn DJ, Rowan EN, Minnet T et al (2003) Extrapyramidal features in Parkinson’s disease with and without dementia and dementia with Lewy bodies: a cross-sectional comparative study. Mov Disord 18:884–889
Simard M, Van Reekum R, Cohen T (2000) A review of the cognitive and behavioural symptoms in dementia with Lewy bodies. J Neuropsychiatry Clin Neurosci 12:425–450
Rahkonen T, Eloniemi-Sulkava U, Rissanen S et al (2003) Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 74:720–724
McKeith IG, Dickson DW, Lowe J et al (2005) Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 65:1863–1872
Olichney JM, Murphy C, Hofstetter CR et al (2005) Anosmia is very common in the Lewy body variant of Alzheimer’s disease. J Neurol Neurosurg Psychiatry 76:1342–1347
Metzler-Baddeley C (2007) A review of cognitive impairments in dementia with Lewy bodies relative to Alzheimer’s disease and Parkinson’s disease with dementia. Cortex 43:583–600
Author information
Authors and Affiliations
Corresponding author
Additional information
Authors’ names are listed in alphabetical order as the contributions of all were essential to the study. E.C. provided the statistical workout; A.F. made the proposal of the study and rendered the data from the archives suitable for the analyses; H.S. wrote the paper
Rights and permissions
About this article
Cite this article
Capitani, E., Francescani, A. & Spinnler, H. Are hallucinations and extrapyramidal signs associated with a steeper cognitive decline in degenerative dementia patients?. Neurol Sci 28, 245–250 (2007). https://doi.org/10.1007/s10072-007-0830-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-007-0830-0