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Frontotemporal dementia and dementia with Lewy bodies in a case-control study of Alzheimer's disease

Published online by Cambridge University Press:  01 August 2009

Olivier Piguet ,
Glenda M. Halliday ,
Helen Creasey ,
G. Anthony Broe  and
Jillian J. Kril
Olivier Piguet*
Affiliation:
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia
Glenda M. Halliday
Affiliation:
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia
Helen Creasey
Affiliation:
Centre for Education and Research on Ageing and University of Sydney, Sydney, Australia
G. Anthony Broe
Affiliation:
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia Prince of Wales Hospital, Randwick, Sydney, Australia
Jillian J. Kril
Affiliation:
Disciplines of Medicine and Pathology, University of Sydney, Sydney, Australia
*
Correspondence should be addressed to: Olivier Piguet, Prince of Wales Medical Research Institute, Barker St, Randwick NSW 2031, Australia. Phone: +61 2 9399 1113; Fax: +61 2 9399 1047. Email: o.piguet@powmri.edu.au.
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Abstract

Background: The clinical presentations in dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD) overlap considerably with that of Alzheimer's disease (AD) despite different pathological processes. Autopsy studies have also shown that multiple brain pathology occurs frequently, even in cases with a single clinical diagnosis. We aimed to determine the frequency of clinical diagnosis of FTD and DLB and the underlying pathology in a well-characterized cohort of patients with a clinical diagnosis of probable or possible AD.

Methods: We conducted a retrospective analysis of 170 AD patients (probable AD = 83; possible AD = 87) originally enrolled in a case-control study, 27 with postmortem examination, to establish the number of cases meeting probable diagnosis for FTD and DLB, using a checklist of features compiled from their consensus criteria.

Results: 23/83 probable AD cases and 32/87 possible AD cases met probable criteria for another dementia, more commonly DLB than FTD. AD pathology was present in 8/15 probable AD and 8/12 possible AD cases coming to autopsy. DLB pathology was seen in four cases and FTD pathology in eight cases. In the AD cases reaching clinical diagnosis for a second dementia syndrome and coming to autopsy, a minority showed non-AD pathology only.

Conclusions: Presence of core clinical features of non-AD dementia syndromes is common in AD. Concordance between clinical and pathological diagnoses of dementia remains variable. We propose that repeat clinical examinations and structural neuroimaging will improve diagnostic accuracy. In addition, clinical diagnostic criteria for the main dementia syndromes require refinement.

Keywords

ADdiagnostic criteriaDLBFTDneuropathology
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 4 , August 2009 , pp. 688 - 695
Copyright
Copyright © International Psychogeriatric Association 2009

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