Alzheimer disease (AD) co-pathology is associated with presence and severity of neuropsychiatric symptoms in Lewy body dementia, according to recent findings presented at MDS Virtual Congress 2021.

“We were trying to identify the associations between AD co-pathology and the neuropsychiatric symptoms that we see in patients with Lewy body dementia,” Joseph DiPane, medical student, University of California San Diego, La Jolla, CA, and co-researchers.

About 50% of patients with Lewy body dementia have AD co-pathology on autopsy, though there is little research on neuropsychiatric symptom associations of AD co-pathology.

Researchers obtained data on visits conducted at 33 AD research centers between September 2005 and August 2019 from the National Alzheimer’s Coordinating Center Uniform Data Set and Neuropathology Data Set. Patients included were clinically diagnosed with Lewy body dementia at last visit before death, with confirmation of neuropathology.  A total of 288 patients were reviewed in this autopsy-validated cohort study. Patients were divided into 3 cohorts based on their AD neuropathological change.

Neuropsychiatric Inventory-Questionnaire scores to assess neuropsychiatric symptom severity were compared to AD neurotheological change using linear models with controls for age, sex, education, and severity of dementia.

Severe AD co-pathology was associated with lower scores on the Neuropsychiatric Inventory-Questionnaire, in addition to lower likelihood of depression, apathy, and delusion. Additionally, severe AD co-pathology was associated with less severe hallucinations, delusion, disinhibition, and anxiety . These patients were more likely to experience significant changes in their appetite or eating habits.

“In this large, autopsy-validated cohort of [Lewy body dementia]LBD patients, AD co-pathology contributes to the presence and severity of neuropsychiatric symptoms in LBD. Further assessment of the neuropsychiatric features at LBD onset and during the course of the disease in pathologically validated samples can help better elucidate clinicopathological correlations and improve ante-mortem diagnostic accuracy in LBD,” concluded DiPane et al.

J. DiPane, D. Coughlin, E. Bayram. Association between Alzheimer’s disease co-pathology and neuropsychiatric symptoms in Lewy body dementia. Presented at MDS Congress 2021; September 17-22. Virtual.