Medscape Medical News offers an email summary of medical journal articles. In yesterday’s email, they offered a summary of a new three-minute test to diagnose Lewy Body Dementia. The test is developed by Dr. Jim Galvin, an LBD expert. I’ve copied the summary below, plus a link to the journal article that describes the test.
I need to read the full medical journal article but the last one I read along these lines (that focused on fluctuating cognition) didn’t truly differentiate those with Lewy Body Dementia, Alzheimer’s, or Parkinson’s. We know from brain donation that lots of people don’t have “pure” LBD; they have LBD and AD. So I’m not sure how helpful such a three-minute test is. (Note that I’ve helped one of Dr. Galvin’s patients with brain donation. Dr. Galvin diagnosed the gentleman as having LBD; autopsy showed not a single Lewy body in the brain.)
Here are four key points from the summary:
- LBD includes both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia. The new test, called the Lewy body composite risk score (LBCRS), was derived from clinical features in autopsy-verified cases of healthy controls, Alzheimer’s disease (AD), DLB, and PD with and without dementia.
Robin’s note: The autopsy-verified cases of AD, DLB, PD, and healthy controls were described in a study in 2006. In that study, “Features that predicted Lewy bodies at autopsy included extrapyramidal signs, cognitive fluctuations, hallucinations, and sleep disturbances.” Only 20 DLB brain donors were included in that study. That’s not a very big number.
- Such a test might speed up a diagnosis of DLB and spare families a lot of strain and patients possible harm. An earlier study showed that these patients “had to see multiple doctors over multiple visits and 50% of the time they got a wrong diagnosis that eventually had to be corrected,” said Dr Galvin.
- (Dr. Galvin) added that half of the wrong diagnoses weren’t harmful, but the other half could have been. For example, some patients were diagnosed with a psychiatric disorder, such as schizophrenia “even though they were in their 70s and 80s,” and were put on the antipsychotic haloperidol, which is “potentially harmful and possibly fatal in this population,” he said. Some patients were never given a diagnosis at all, even after seeing multiple doctors. “People were wondering what was going on and nobody was there to help them,” said Dr Galvin.
- But would [a correct diagnosis of Robin Williams] have saved his life? “While Lewy body dementia itself doesn’t increase the risk for suicide, if you have someone who is not correctly diagnosed or isn’t completely diagnosed and they don’t know what’s going on, they can make decisions that can be harmful to themselves,” said Dr Galvin.
See: www.medscape.com/viewarticle/854577 (You need to be a registered user for access. I believe registration is free.)
Medscape Medical News > Neurology
Three-Minute Test for Lewy Body Dementia
Pauline Anderson
November 16, 2015
Robin