Skip to main content

Advertisement

SpringerLink
Log in

Neuropsychiatric symptoms and α-Synuclein profile of patients with Parkinson’s disease dementia, dementia with Lewy bodies and Alzheimer’s disease

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Introduction

Given the overlapping of neuropathological, neurochemical and neuropsychiatric profiles of Parkinson’s disease dementia (PDD), dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD), their differential diagnosis is challenging. Specific neuropsychiatric features or biomarkers, such as cerebrospinal fluid (CSF) α-Synuclein (α-Syn), may aid in differential diagnosis. This study aims to compare the neuropsychiatric and CSF α-Syn profiles in these conditions, and to investigate the possible association between CSF α-Syn levels and neuropsychiatric symptoms.

Methods

We conducted a prospective cross-sectional study, between January 2013 and January 2015, with 16 PDD, 28 DLB and 19 AD patients. All participants underwent a detailed clinical, neuropsychological, neuropsychiatric [Neuropsychiatric Inventory (NPI)] and CSF α-Syn analysis.

Results

Significantly greater NPI Hallucinations Subitem score was found in the PDD and DLB groups compared to AD (both p < 0.001). NPI Agitation score was greater in the DLB compared to PDD group (p = 0.012). NPI Sleep score was greater in the DLB compared to AD group (p = 0.001). Total NPI score was greater in the DLB compared to AD and PDD groups. To discriminate between the DLB and AD and between DLB and PDD groups, logistic regression analysis showed that both NPI scores and α-Syn levels were independently associated. There was no correlation between NPI scores and α-Syn levels. Increased NPI scores and α-Syn levels are associated with greater likelihood for being in DLB than in PDD or AD groups. ROC analysis showed that the combination of NPI and α-Syn increases the discriminative ability of each marker alone (p < 0.001) with AUC equal to 0.95 (95% CI 0.91–0.99).

Conclusion

NPI scores and CSF α-Syn levels were useful as independent variables to differentiate DLB from PDD and AD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aarsland D, Rongve A, Nore SP et al (2008) Frequency and case identification of dementia with Lewy bodies using the revised consensus criteria. Dement Geriatr Cogn Disord 26(5):445–452

    Article  Google Scholar 

  2. Berg D, Postuma RB, Bloem BP et al (2014) Time to redefine PD? Introductory statement of the MDS Task Force on the definition of Parkinson’s disease. Mov Disord 29:454–462

    Article  Google Scholar 

  3. Mandal PK, Pettegrew JW, Masliah E et al (2006) Interaction between Ab peptide and a synuclein: molecular mechanisms in overlapping pathology of Alzheimer’s and Parkinson’s in dementia with Lewy body disease. Neurochem Res 31:1153–1162

    Article  CAS  Google Scholar 

  4. Hepp DH, Vergoossen DL, Huisman E et al (2016) Distribution and load of amyloid-β pathology in Parkinson disease and dementia with Lewy bodies. J Neuropathol Exp Neurol 75(10):936–945

    Article  CAS  Google Scholar 

  5. Starkstein SE, Sabe L, Petracca G et al (1996) Neuropsychological and psychiatric differences between Alzheimer’sdisease and Parkinson’s disease with dementia. J Neurol Neurosurg Psychiatry 61:381–387

    Article  CAS  Google Scholar 

  6. Kao AW, Racine CA, Quitania LC et al (2009) Cognitive and neuropsychiatric profile of the synucleinopathies: Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy. Alzheimer Dis Assoc Disord 23:365–370

    Article  Google Scholar 

  7. Aarsland D, Cummings JL, Larsen JP (2001) Neuropsychiatric difference between Parkinson’s disease with dementia and Alzheimer’s disease. Int J Geriatr Psychiatry 16:184–191

    Article  CAS  Google Scholar 

  8. Noe E, Marder K, Bell KL (2004) Comparison of dementia with Lewy bodies to Alzheimer’s disease and Parkinson’s disease with dementia. Mov Disord 19:60–67

    Article  Google Scholar 

  9. Aarsland D, Ballard C, Larsen JP, Mckeith J (2001) A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson’s disease with and without dementia. Int J Geriatr Psychiatry 16:528–536

    Article  CAS  Google Scholar 

  10. Chiu PY, Tsai CT, Chen PK et al (2016) Neuropsychiatric symptoms in Parkinson’s disease dementia are more similar to Alzheimer’s disease than dementia with Lewy bodies: a case-control study. PLoS One 11(4):e0153989

    Article  Google Scholar 

  11. Hall S, Öhrfelt A, Constantinescu R et al (2012) Accuracy of a panel of 5 cerebrospinal fluid biomarkers in the differential diagnosis of patients with dementia and/or Parkinsonian disorders. Arch Neurol 69:1445

    Article  Google Scholar 

  12. Wennström M, Surova Y, Hall S et al (2013) Low CSF levels of both α-synuclein and the α-synuclein cleaving enzyme neurosin in patients with synucleinopathy. PLoS One 8:e53250

    Article  Google Scholar 

  13. Reesink FE, Lemstra AW, van Dijk KD et al (2010) CSF α-synuclein does not discriminate dementia with Lewy bodies from Alzheimer’s disease. J Alzheimers Dis 22:87–95

    Article  CAS  Google Scholar 

  14. Kapaki E, Paraskevas GP, Emmanouilidou E, Vekrellis K (2013) The diagnostic value of CSF α-synuclein in the differential diagnosis of dementia with Lewy bodies vs. normal subjects and patients with Alzheimer’s disease. PLoS One 8(11):e81654

    Article  Google Scholar 

  15. Emre M, Aarsland D, Brown R et al (2007) Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord 22:1689–1707

    Article  Google Scholar 

  16. McKeith IG, Dickson DW, Lowe J et al (2005) Consortium on DLB, diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65:1863–1872

    Article  CAS  Google Scholar 

  17. McKhann Guy M, Knopman DS, Chertkow H et al (2011) The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s Dement 7:263–269

    Article  CAS  Google Scholar 

  18. Politis AM, Mayer LS, Passa M et al (2004) Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer’s disease: a study of disturbing behaviors among referrals to a memory clinic. Int J Geriatr Psychiatry 19:203–208

    Article  Google Scholar 

  19. Morris JC (1993) The clinical dementia rating (CDR): current version and scoring rules. Neurology 43:2412–2414

    Article  CAS  Google Scholar 

  20. Folstein M, Folstein S, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  Google Scholar 

  21. del Campo M, Mollenhauer B, Bertolotto A et al (2012) Recommendations to standardize preanalytical confounding factors in Alzheimer’s and Parkinson’s disease cerebrospinal fluid biomarkers: an update. Biomark Med 6:419–430

    Article  Google Scholar 

  22. Emmanouilidou E, Elenis D, Papasilekas T et al (2011) Assessment of α-synuclein secretion in mouse and human brain parenchyma. PLoS One 6(7):e22225

    Article  CAS  Google Scholar 

  23. Tateno F, Sakakibara R, Kawai T et al (2012) Alpha-synuclein in the cerebrospinal fluid differentiates synucleinopathies (Parkinson disease, dementia with Lewy bodies, multiple system atrophy) from Alzheimer disease. Alzheimer Dis Assoc Disord 26(3):213–216

    Article  CAS  Google Scholar 

  24. Perry RH, Irving D, Blessed G et al (1995) Senile dementia of Lewy body type. A clinically and neuropathologically distinct type of Lewy body dementia in the elderly. J Neurol Sci 95:119–139

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All authors report no financial disclosures.

Author information

Authors and Affiliations

  1. 1st Department of Neurology, Memory and Movement Disorder Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Anastasia Bougea, Leonidas Stefanis, George P. Paraskevas, Efthimia Efthymiopoulou & Elisabeth Kapaki

  2. Department of Neuroscience, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece

    Anastasia Bougea, Leonidas Stefanis, Evangelia Emmanouilidou & Kostas Vekrelis

Authors
  1. Anastasia Bougea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonidas Stefanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George P. Paraskevas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evangelia Emmanouilidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Efthimia Efthymiopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kostas Vekrelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elisabeth Kapaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anastasia Bougea.

Ethics declarations

Conflicts of interest

All authors have no interest to declare.

Ethical standards

This study conformed to the Ethical Guidelines for Medical and Health Research Involving Human Subjects endorsed by the Greek government and was approved by the Ethics Committee of National and Kapodistrian University Graduate School of Medicine. This study does not involve any methods or experiments with animals.

Informed consent

All study participants provided informed consent prior to inclusion in the study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bougea, A., Stefanis, L., Paraskevas, G.P. et al. Neuropsychiatric symptoms and α-Synuclein profile of patients with Parkinson’s disease dementia, dementia with Lewy bodies and Alzheimer’s disease. J Neurol 265, 2295–2301 (2018). https://doi.org/10.1007/s00415-018-8992-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8992-7

Keywords

Search

Navigation