Attention and fluctuating attention in patients with dementia with lewy bodies and alzheimer disease

Ballard, C. and O'Brien, J. and Gray, A. and Cormack, F. and Ayre, G. and Rowan, E. and Thompson, P. and Bucks, R. and McKeith, I. and Walker, M. and Tovee, M. (2001) Attention and fluctuating attention in patients with dementia with lewy bodies and alzheimer disease. Archives of Neurology, 58 (6). pp. 977-982. ISSN 0003-9942

Full content URL: https://doi.org/10.1001/archneur.58.6.977

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Abstract

Background: Attentional deficits are described in the consensus clinical criteria for the operationalized diagnosis of dementia with Lewy bodies (DLB) as characteristic of the condition. In addition, preliminary studies have indicated that both attentional impairments and fluctuation of attentional impairments are more marked in patients with DLB than in patients with Alzheimer disease (AD), although neuropsychological function has not previously been examined in a large prospective cohort with confirmed diagnostic accuracy against postmortem diagnosis. Methods: A detailed evaluation of attention and fluctuating attention was undertaken in 155 patients with dementia (85 with DLB and 80 with AD) from a representative hospital dementia case register and 35 elderly controls using the Cognitive Drug Research Computerized Assessment System for Dementia Patients computerized neuropsychological battery. Operationalized clinical diagnosis was made using the consensus criteria for DLB and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD. High levels of sensitivity and specificity have been achieved for the first 50 cases undergoing postmortem examination. Results: The groups were well matched for severity of cognitive impairments, bur the AD patients were older (mean age, 80 vs 78 years) and more likely to be female (55 vs 40). Patients with DLB were significantly more impaired than patients with AD on all measures of attention and fluctuating attention (for all comparisons, t � 2.5, P<.001), and patients from both dementia groups were significantly more impaired than elderly controls for all comparisons other than cognitive reaction time, which was significantly more impaired in DLB patients than controls but was comparable in controls and AD patients. There were, however, significant associations between the severity of cognitive impairment and the severity of both attentional deficits and fluctuations in attention. Conclusions: This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction rime appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits.

Keywords:Alzheimer disease, attention, cognitive defect, dementia, diffuse Lewy body disease, Cognition Disorders, Lewy Body Disease, Neuropsychological Tests, Reaction Time
Subjects:C Biological Sciences > C800 Psychology
C Biological Sciences > C850 Cognitive Psychology
C Biological Sciences > C830 Experimental Psychology
C Biological Sciences > C841 Health Psychology
C Biological Sciences > C840 Clinical Psychology
Divisions:College of Social Science > School of Psychology
ID Code:24525
Deposited On:24 Aug 2017 14:41

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