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Am J Psychiatry 1996; 153:1269-1273
Copyright © 1996 by American Psychiatric Association
Alzheimer's disease and its Lewy body variant: a clinical analysis of postmortem verified cases
MF Weiner, RC Risser, CM Cullum, L Honig, C White 3rd, S Speciale and RN Rosenberg
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-9070, USA.
OBJECTIVE: The authors compared clinical findings of Alzheimer's disease
and the so-called Lewy body variant of Alzheimer's disease. METHOD:
Available data were analyzed on the clinical features of 58 patients with
Alzheimer's disease and 24 patients with the Lewy body variant of
Alzheimer's disease who underwent postmortem examination. RESULTS: The
proportion of men was significantly larger in the Lewy body variant group
than in the Alzheimer's disease group (66.7% versus 34.5%), and,
concordantly, the Lewy body variant group was slightly taller. The
prevalence of hallucinations and delusions was significantly higher in Lewy
body variant subjects than the Alzheimer's disease subjects, but there were
no significant differences between the two groups in educational
attainment, family history of dementia, age at onset, duration of illness,
cognitive impairment, overall severity of illness, or neuropsychological
findings. Patients with the Lewy body variant of Alzheimer's disease tended
to experience more frequent extrapyramidal side effects of neuroleptics
than did the patients with Alzheimer's disease, but for patients in the two
groups who were not exposed to neuroleptics, there was little difference in
frequency of extrapyramidal side effects. CSF concentration of homovanillic
acid (HVA) was significantly lower in the Lewy body variant patients, even
when correction was made for height. CONCLUSIONS: The Lewy body variant of
Alzheimer's disease may be suspected in elderly male dementia patients who
otherwise meet criteria for Alzheimer's disease but who manifest
significant psychiatric symptoms and neuroleptic-induced extrapy-ramidal
side effects and have low levels of CSF HVA.
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