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The influence of cerebrovascular disease in dementia with Lewy bodies and Parkinson’s disease dementia.

Accepted version
Peer-reviewed

Type

Article

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Authors

Yassi, Nawaf 
O'Brien, John 
Watson, Rosie 

Abstract

Introduction: Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), is a common form of neurodegenerative dementia. The frequency and influence of comorbid cerebrovascular disease is not understood but has potentially important clinical management implications. Methods: A systematic literature search was conducted (Medline and Embase) for studies including participants with DLB and/or PDD assessing cerebrovascular lesions (imaging and pathological studies). They included white matter changes, cerebral amyloid angiopathy (CAA), cerebral microbleeds (CMB), macroscopic infarcts, micro-infarcts and intracerebral haemorrhage. Results: Of 4411 articles, 63 studies were included. Cerebrovascular lesions commonly studied included white matter changes (41 studies) and CMB (18 studies). There was an increased severity of white matter changes on magnetic resonance imaging (visualized as white matter hyperintensities, WMH), but not neuropathology, in LBD compared to PD without dementia and age-matched controls. CMB prevalence in DLB was highly variable but broadly similar to Alzheimer’s disease (AD) (0-48%), with a lobar predominance. No relationship was found between large cortical or small subcortical infarcts or intracerebral haemorrhage and presence of LBD. Conclusion: The underlying mechanisms of WMH in LBD require further exploration, as their increased severity in LBD was not supported by neuropathological examination of white matter. CMB in LBD had a similar prevalence as AD. There is a need for larger studies assessing the influence of cerebrovascular lesions on clinical symptoms, disease progression and outcomes.

Description

Keywords

Lewy body disease, cerebrovascular disorders, neuroimaging, Alzheimer Disease, Cerebrovascular Disorders, Dementia, Humans, Lewy Body Disease, Parkinson Disease

Journal Title

European Journal of Neurology

Conference Name

Journal ISSN

1351-5101
1468-1331

Volume Title

Publisher

Wiley
Sponsorship
Funding: This work was supported by the Dementia Australia Research Fellowship award