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. 1989 Jun;52(6):709–717. doi: 10.1136/jnnp.52.6.709

Diffuse Lewy body disease: clinical features in 15 cases.

E J Byrne 1, G Lennox 1, J Lowe 1, R B Godwin-Austen 1
PMCID: PMC1032020  PMID: 2545827

Abstract

Fifteen cases of diffuse Lewy body disease were diagnosed on pathological grounds during a single year in one health district. The range and frequency of clinical features contrast strikingly with previous reports. The majority of cases presented with classical levodopa-responsive Parkinson's disease either alone (6 cases) or with mild cognitive impairment (3 cases); the remaining 6 cases presented with cognitive impairment alone. In time almost all patients developed both dementia and Parkinsonism. The dementia was cortical in type, but unusual in that most (12 cases) showed day-to-day fluctuation in severity at some point in their illness. These findings suggest that diffuse Lewy body disease is not rare, and that it presents in a range of ways from dementia with subsequent Parkinsonism to Parkinson's disease with subsequent dementia. The latter mode of presentation suggests that it should be considered as a significant pathological substrate of dementia in Parkinson's disease.

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Selected References

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  1. Beppu H., Nagaoka M., Tanaka R. Analysis of cerebellar motor disorders by visually-guided elbow tracking movement. 2. Contribution of the visual cues on slow ramp pursuit. Brain. 1987 Feb;110(Pt 1):1–18. doi: 10.1093/brain/110.1.1. [DOI] [PubMed] [Google Scholar]
  2. Byrne E. J., Lowe J., Godwin-Austen R. B., Arie T., Jones R. Dementia and Parkinson's disease associated with diffuse cortical Lewy bodies. Lancet. 1987 Feb 28;1(8531):501–501. doi: 10.1016/s0140-6736(87)92104-0. [DOI] [PubMed] [Google Scholar]
  3. Clark A. W., White C. L., 3rd, Manz H. J., Parhad I. M., Curry B., Whitehouse P. J., Lehmann J., Coyle J. T. Primary degenerative dementia without Alzheimer pathology. Can J Neurol Sci. 1986 Nov;13(4 Suppl):462–470. doi: 10.1017/s0317167100037136. [DOI] [PubMed] [Google Scholar]
  4. Cross R. B. Demonstration of neurofibrillary tangles in paraffin sections: a quick and simple method using a modification of Palmgren's method. Med Lab Sci. 1982 Jan;39(1):67–69. [PubMed] [Google Scholar]
  5. Delisle M. B., Gorce P., Hirsch E., Hauw J. J., Rascol A., Bouissou H. Motor neuron disease, parkinsonism and dementia. Report of a case with diffuse Lewy body-like intracytoplasmic inclusions. Acta Neuropathol. 1987;75(1):104–108. doi: 10.1007/BF00686799. [DOI] [PubMed] [Google Scholar]
  6. Dickson D. W., Davies P., Mayeux R., Crystal H., Horoupian D. S., Thompson A., Goldman J. E. Diffuse Lewy body disease. Neuropathological and biochemical studies of six patients. Acta Neuropathol. 1987;75(1):8–15. doi: 10.1007/BF00686786. [DOI] [PubMed] [Google Scholar]
  7. Ditter S. M., Mirra S. S. Neuropathologic and clinical features of Parkinson's disease in Alzheimer's disease patients. Neurology. 1987 May;37(5):754–760. doi: 10.1212/wnl.37.5.754. [DOI] [PubMed] [Google Scholar]
  8. Eggertson D. E., Sima A. A. Dementia with cerebral Lewy bodies. A mesocortical dopaminergic defect? Arch Neurol. 1986 May;43(5):524–527. doi: 10.1001/archneur.1986.00520050094034. [DOI] [PubMed] [Google Scholar]
  9. Forno L. S., Barbour P. J., Norville R. L. Presenile dementia with Lewy bodies and neurofibrillary tangles. Arch Neurol. 1978 Dec;35(12):818–822. doi: 10.1001/archneur.1978.00500360042008. [DOI] [PubMed] [Google Scholar]
  10. Goldman J. E., Yen S. H., Chiu F. C., Peress N. S. Lewy bodies of Parkinson's disease contain neurofilament antigens. Science. 1983 Sep 9;221(4615):1082–1084. doi: 10.1126/science.6308771. [DOI] [PubMed] [Google Scholar]
  11. Ikeda K., Hori A., Bode G. Progressive dementia with "diffuse Lewy-type inclusions' in cerebral cortex. A case report. Arch Psychiatr Nervenkr (1970) 1980;228(3):243–248. doi: 10.1007/BF00342349. [DOI] [PubMed] [Google Scholar]
  12. Ikeda K., Ikeda S., Yoshimura T., Kato H., Namba M. Idiopathic Parkinsonism with Lewy-type inclusions in cerebral cortex. A case report. Acta Neuropathol. 1978 Feb 20;41(2):165–168. doi: 10.1007/BF00689769. [DOI] [PubMed] [Google Scholar]
  13. Itoh T., Momma Y., Ogasawara N. An electron microscopic study on atypical presenile dementia with numerous Lewy bodies in the cerebral cortex. Folia Psychiatr Neurol Jpn. 1982;36(1):99–106. doi: 10.1111/j.1440-1819.1982.tb00260.x. [DOI] [PubMed] [Google Scholar]
  14. Kosaka K. Lewy bodies in cerebral cortex, report of three cases. Acta Neuropathol. 1978 May 24;42(2):127–134. doi: 10.1007/BF00690978. [DOI] [PubMed] [Google Scholar]
  15. Kosaka K., Mehraein P. Dementia-Parkinsonism syndrome with numerous Lewy bodies and senile plaques in cerebral cortex. Arch Psychiatr Nervenkr (1970) 1979 Apr 12;226(4):241–250. doi: 10.1007/BF00342237. [DOI] [PubMed] [Google Scholar]
  16. Kosaka K., Oyanagi S., Matsushita M., Hori A. Presenile dementia with Alzheimer-, Pick- and Lewy-body changes. Acta Neuropathol. 1976 Nov 15;36(3):221–233. doi: 10.1007/BF00685366. [DOI] [PubMed] [Google Scholar]
  17. Kosaka K., Shibayama H., Kobayashi H., Hoshino T., Iwase S. [An autopsy case of unclassifiable presenile dementia]. Seishin Shinkeigaku Zasshi. 1973 Jan;75(1):18–34. [PubMed] [Google Scholar]
  18. Kosaka K., Yoshimura M., Ikeda K., Budka H. Diffuse type of Lewy body disease: progressive dementia with abundant cortical Lewy bodies and senile changes of varying degree--a new disease? Clin Neuropathol. 1984 Sep-Oct;3(5):185–192. [PubMed] [Google Scholar]
  19. Kuroda S., Hosokawa K., Iguchi K., Tateishi J. [An autopsy case of presenile dementia with numerous Lewy bodies in the cerebral cortex (author's transl)]. Rinsho Shinkeigaku. 1978 Jun;18(6):346–350. [PubMed] [Google Scholar]
  20. Kuyama K., Kuroda S., Otsuki S., Shinagawa S., Morioka E. [An autopsy case of "Lewy body disease" presenting dementia]. Rinsho Shinkeigaku. 1987 Jan;27(1):94–98. [PubMed] [Google Scholar]
  21. Lowe J., Blanchard A., Morrell K., Lennox G., Reynolds L., Billett M., Landon M., Mayer R. J. Ubiquitin is a common factor in intermediate filament inclusion bodies of diverse type in man, including those of Parkinson's disease, Pick's disease, and Alzheimer's disease, as well as Rosenthal fibres in cerebellar astrocytomas, cytoplasmic bodies in muscle, and mallory bodies in alcoholic liver disease. J Pathol. 1988 May;155(1):9–15. doi: 10.1002/path.1711550105. [DOI] [PubMed] [Google Scholar]
  22. Mitsuyama Y., Fukunaga H., Yamashita M. Alzheimer's disease with widespread presence of Lewy bodies. Folia Psychiatr Neurol Jpn. 1984;38(1):81–88. doi: 10.1111/j.1440-1819.1984.tb00357.x. [DOI] [PubMed] [Google Scholar]
  23. OKAZAKI H., LIPKIN L. E., ARONSON S. M. Diffuse intracytoplasmic ganglionic inclusions (Lewy type) associated with progressive dementia and quadriparesis in flexion. J Neuropathol Exp Neurol. 1961 Apr;20:237–244. doi: 10.1097/00005072-196104000-00007. [DOI] [PubMed] [Google Scholar]
  24. Okeda R., Kayano T., Funata N., Kojima T., Miki M., Iwama H. [An autopsy case of Parkinson's disease associated clinically with dementia terminating in akinetic mutism and pathologically with multiple Lewy's Bodies in the cerebral cortex]. No To Shinkei. 1982 Aug;34(8):761–767. [PubMed] [Google Scholar]
  25. Pearce J. The extrapyramidal disorder of Alzheimer's disease. Eur Neurol. 1974;12(2):94–103. doi: 10.1159/000114608. [DOI] [PubMed] [Google Scholar]
  26. Philpot M., Colgan J., Janota I., Levy R. Dementia without Alzheimer pathology. Neurology. 1986 Jan;36(1):133–133. doi: 10.1212/wnl.36.1.133. [DOI] [PubMed] [Google Scholar]
  27. Rajput A. H., Offord K. P., Beard C. M., Kurland L. T. A case-control study of smoking habits, dementia, and other illnesses in idiopathic Parkinson's disease. Neurology. 1987 Feb;37(2):226–232. doi: 10.1212/wnl.37.2.226. [DOI] [PubMed] [Google Scholar]
  28. Sima A. A., Clark A. W., Sternberger N. A., Sternberger L. A. Lewy body dementia without Alzheimer changes. Can J Neurol Sci. 1986 Nov;13(4 Suppl):490–497. doi: 10.1017/s0317167100037185. [DOI] [PubMed] [Google Scholar]
  29. Stern Y., Mayeux R., Sano M., Hauser W. A., Bush T. Predictors of disease course in patients with probable Alzheimer's disease. Neurology. 1987 Oct;37(10):1649–1653. doi: 10.1212/wnl.37.10.1649. [DOI] [PubMed] [Google Scholar]
  30. WOODARD J. S. Concentric hyaline inclusion body formation in mental disease analysis of twenty-seven cases. J Neuropathol Exp Neurol. 1962 Jul;21:442–449. doi: 10.1097/00005072-196207000-00012. [DOI] [PubMed] [Google Scholar]
  31. Yagishita S., Itoh Y., Amano N., Nakano T. Atypical senile dementia with widespread Lewy type inclusion in the cerebral cortex. Acta Neuropathol. 1980;49(3):187–191. doi: 10.1007/BF00707105. [DOI] [PubMed] [Google Scholar]
  32. Yoshimura M. Cortical changes in the parkinsonian brain: a contribution to the delineation of "diffuse Lewy body disease". J Neurol. 1983;229(1):17–32. doi: 10.1007/BF00313493. [DOI] [PubMed] [Google Scholar]

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