OBJECTIVES: To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). To determine whether the quality of the fluctuations differs between DLB and AD. To examine the clinical utility of two recently developed rating scales. METHODS: Care givers of 13 patients with early probable DLB and 12 patients with early probable AD were interviewed using the Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale, both developed recently. Descriptions of fluctuating cognition were recorded verbatim, analysed, and rated. RESULTS: Descriptions of fluctuating cognition in DLB had a spontaneous, periodic, transient quality, which appeared to reflect an interruption in the ongoing flow of awareness or attention that impacted on functional abilities. Descriptions of fluctuations in AD frequently highlighted episodes of memory failure, or a more enduring state shift in the form of "good" and "bad" days, typically occurring in response to the cognitive demands of the immediate environment. These qualitative differences could be detected reliably by independent raters, but were not always captured in standard severity scores. CONCLUSION: Fluctuations occurring in DLB have particular characteristics that are distinguishable from fluctuations occurring in AD. Interpretation and application of the fluctuation criterion continues to limit the diagnostic sensitivity of the consensus criteria for DLB. Findings suggest that explicit documentation and a wider appreciation of these distinctions could improve the reliability with which less experienced clinicians identify this core diagnostic feature in the clinical setting.
OBJECTIVES: To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). To determine whether the quality of the fluctuations differs between DLB and AD. To examine the clinical utility of two recently developed rating scales. METHODS: Care givers of 13 patients with early probable DLB and 12 patients with early probable AD were interviewed using the Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale, both developed recently. Descriptions of fluctuating cognition were recorded verbatim, analysed, and rated. RESULTS: Descriptions of fluctuating cognition in DLB had a spontaneous, periodic, transient quality, which appeared to reflect an interruption in the ongoing flow of awareness or attention that impacted on functional abilities. Descriptions of fluctuations in AD frequently highlighted episodes of memory failure, or a more enduring state shift in the form of "good" and "bad" days, typically occurring in response to the cognitive demands of the immediate environment. These qualitative differences could be detected reliably by independent raters, but were not always captured in standard severity scores. CONCLUSION: Fluctuations occurring in DLB have particular characteristics that are distinguishable from fluctuations occurring in AD. Interpretation and application of the fluctuation criterion continues to limit the diagnostic sensitivity of the consensus criteria for DLB. Findings suggest that explicit documentation and a wider appreciation of these distinctions could improve the reliability with which less experienced clinicians identify this core diagnostic feature in the clinical setting.
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Authors: M S Mega; D L Masterman; D F Benson; H V Vinters; U Tomiyasu; A H Craig; D J Foti; D Kaufer; D W Scharre; L Fairbanks; J L Cummings Journal: Neurology Date: 1996-12 Impact factor: 9.910
Authors: G C Román; T K Tatemichi; T Erkinjuntti; J L Cummings; J C Masdeu; J H Garcia; L Amaducci; J M Orgogozo; A Brun; A Hofman Journal: Neurology Date: 1993-02 Impact factor: 9.910
Authors: Abhishek Pratap; Elias Chaibub Neto; Phil Snyder; Carl Stepnowsky; Noémie Elhadad; Daniel Grant; Matthew H Mohebbi; Sean Mooney; Christine Suver; John Wilbanks; Lara Mangravite; Patrick J Heagerty; Pat Areán; Larsson Omberg Journal: NPJ Digit Med Date: 2020-02-17
Authors: Sara Varanese; Bernardo Perfetti; Daniela Monaco; Astrid Thomas; Laura Bonanni; Pietro Tiraboschi; Marco Onofrj Journal: J Neurol Date: 2010-01-22 Impact factor: 4.849