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White matter lesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer's disease, vascular dementia, and normal aging

Lookup NU author(s): Dr Robert Barber, Dr Clive Ballard, Professor Ian McKeith, Emeritus Professor Robert Perry, Professor John O'Brien

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Abstract

Objectives-Alzheimer's disease and vascular dementia are associated with an increase in changes in white matter on MRT. The aims were to investigate whether white matter changes also occur in dementia with Lewy bodies and to examine the relation between white matter lesions and the cognitive and noncognitive features of dementia with Lewy bodies, Alzheimer's disease, and vascular dementia. Methods-Proton density and T2 weighted images were obtained on a 1.0 Tesla MRI scanner in patients with dementia with Lewy bodies (consensus criteria; n=27, mean age=75.9 years), Alzheimer's disease (NINCDS/ADRDA; n=28, mean age=77.4 years), vascular dementia (NINDS/AIREN; n=25, mean age=76.8 years), and normal controls (n=26, mean age=76.2 years). Cognitive function, depressive symptoms, and psychotic features were assessed using a standardised protocol. Periventricular hyperintensities (PVHs), white matter hyperintensities (WMHs) and basal ganglia hyperintensities (BGHs) were visually rated blind to diagnosis using a semiquantitative scale. Results-Periventricular hyperintensities were positively correlated with age and were more severe in all dementia groups than controls. Total deep hyperintensities scores (WMHs plus BGHs) were significantly higher in all dementia groups than controls and higher in patients with vascular dementia than those with dementia with Lewy bodies or Alzheimer's disease. In all patients with dementia, frontal WMHs were associated with higher depression scores and occipital WMHs were associated with an absence of visual hallucinations and delusions. Conclusion-In common with Alzheimer's disease and vascular dementia, PVHs and WMHs were significantly more extensive in dementia with Lewy bodies than in controls. This overlap between different dementias may reflect shared pathological mechanisms. The link between frontal WMHs and depression and the absence of occipital WMHs and psychotic symptoms has important implications for understanding the neurobiological basis of these symptoms.


Publication metadata

Author(s): McKeith I; Perry R; O'Brien J; Barber R; Ballard C; Scheltens F; Gholkar A; Ince P

Publication type: Article

Publication status: Published

Journal: Journal of Neurology, Neurosurgery and Psychiatry

Year: 1999

Volume: 67

Issue: 1

Pages: 66-72

Print publication date: 01/07/1999

ISSN (print): 0022-3050

ISSN (electronic):

Publisher: BMJ Group

URL: http://dx.doi.org/10.1136/jnnp.67.1.66

DOI: 10.1136/jnnp.67.1.66


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