Full length articleMotor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease
Introduction
Gait, balance, and motor impairments are common in individuals with dementia and are associated with increased fall risk. Similarities in the clinical presentation of dementia subtypes (i.e., dementia with Lewy bodies) [1], Parkinson’s disease with dementia [1], and Alzheimer’s disease (AD) make differential diagnosis of these conditions challenging. However, evidence suggests that the pattern of motor, gait and balance deficits may differ across subtypes of dementia. Individuals with Lewy body dementia (LBD), including DLB and PDD, demonstrate greater gait impairments and worse balance on the Tinetti Mobility Test (TMT) than individuals with AD [2] and Parkinson’s disease (PD) [3]. Indeed, parkinsonian gait, a hallmark of both DLB and PDD [1], accurately identifies individuals with LBD with a sensitivity of 87% and a specificity of 84% [3] compared to other dementia subtypes. Thus, quantitative motor and gait and balance assessment may be helpful for early differential diagnosis of dementia subtypes and help in earlier interventions for motor symptoms.
Repeated falls are common to DLB, PDD, AD and PD [4]. Increased stride-to-stride variability during walking and when performing simultaneous tasks (i.e., dual-tasks) was more related to dementia than changes in mean gait parameter values [5] and was associated with higher fall risk in the elderly and individuals with PD [6]. Gait and balance assessments including dual-task assessments may assist clinicians in identifying individuals with dementia at fall risk to ensure referrals for targeted rehabilitation and fall prevention.
Substantial overlapping of clinical, neuropathologic, and metabolic features along the PD-PDD-DLB-AD disease spectrum makes accurate diagnosis difficult [7]. No studies have simultaneously examined differences in motor performance measures between individuals with LBD, AD and PD. Thus, the primary objective of this study was to compare the motor profiles of a cohort of selectively matched individuals with LBD, PD, and AD through gait, balance, and hand dexterity testing. With the prevalence of dementias increasing, a comprehensive motor examination that accurately distinguishes between individuals with these diagnoses could improve diagnosis of these dementia subtypes thereby leading to earlier intervention and more effective management of these patients.
Section snippets
Methods
This cross sectional design study complied with the Declaration of Helsinki and was approved by the Institutional Review Board.
Results
Seventy-two individuals were recruited and screened for the study. Sixty-three individuals (21 LBD matched with 21 PD and 21 AD) out of the 72 met inclusion and exclusion criteria (Table 1). No participants used assistive devices for walking. All individuals demonstrated increased variability in backward walking measures compared to forward walking conditions.
Discussion
Our study findings identify for the first time distinct motor profiles associated with individuals with dementia subtypes (DLB, PDD, AD) and PD. In general motor impairments were least severe in AD, more advanced in PD and most pronounced in those with LBD (Fig. 1).
Individuals with LBD showed greater gait, balance, and hand dexterity deficits than those with AD or PD. Performance on the TMT balance subscale differentiated between LBD, AD, and PD groups and between PDD and DLB groups. Study
Financial support
This study was funded by grants from The Mangurian Foundation, the Dr. Thomas H. and Mrs. Kelly Mallory Fund and the Robert A. Vaughan Family Fund. The funders had no involvement in the study design, data collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
Acknowledgements
The authors thank Shu-Ing Chang for her contributions. We also acknowledge biostatistician Greg Young for his review of the statistics.
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