Dementia and Neurocognitive Disorders (대한치매학회지)

Korean Dementia Association (대한치매학회)
권호 표지
DOI QR코드

DOI QR Code

Development and Validation of a Screening Questionnaire for Dementia With Lewy Bodies (DLB): the DLB Screening Questionnaire (DLBSQ)

  • Mincheol Park (Department of Neurology, Yonsei University College of Medicine) ;
  • Kyoungwon Baik (Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Young H. Sohn (Department of Neurology, Yonsei University College of Medicine) ;
  • Byoung Seok Ye (Department of Neurology, Yonsei University College of Medicine)
  • Received : 2023.11.08
  • Accepted : 2024.01.08
  • Published : 2024.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background and Purpose: Although dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia, its clinical prevalence is low. We developed a short and easy-to-complete DLB screening questionnaire (DLBSQ) to raise diagnostic sensitivity in routine clinical settings. Methods: A total of 501 participants were retrospectively enrolled, including 71 controls, 184 patients without DLB, and 246 patients with probable DLB. All patients underwent clinical evaluation, including core features of DLB, the DLBSQ, brain magnetic resonance imaging, and detailed neuropsychological assessments. The diagnostic performance of the DLBSQ for probable DLB was investigated using a receiver operating characteristic curve analysis. Results: Total DLBSQ score was associated with visuospatial and frontal/executive dysfunction and the diagnosis of probable DLB. The area under the receiver operating characteristic curve for total DLBSQ score was 0.727. Youden's method revealed an optimal cutoff value of 3. The sensitivity and specificity of the DLBSQ were 68.7% and 62.4%, respectively. Its discriminating performance improved when cognitive test profiles were additionally considered (area under the curve: 0.822, sensitivity: 80.6%, and specificity: 70.4%). Conclusions: The DLBSQ might be a useful screening tool for DLB in routine clinical practice with good sensitivity and specificity.

Keywords

References

  1. Walker Z, Possin KL, Boeve BF, Aarsland D. Lewy body dementias. Lancet 2015;386:1683-1697. 
  2. Vann Jones SA, O'Brien JT. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 2014;44:673-683.
  3. Boot B. The incidence and prevalence of dementia with Lewy bodies is underestimated. Psychol Med 2013;43:2687-2688.
  4. Kane JP, Surendranathan A, Bentley A, Barker SA, Taylor JP, Thomas AJ, et al. Clinical prevalence of Lewy body dementia. Alzheimers Res Ther 2018;10:19.
  5. Jellinger KA, Attems J. Prevalence and pathology of dementia with Lewy bodies in the oldest old: a comparison with other dementing disorders. Dement Geriatr Cogn Disord 2011;31:309-316. 
  6. Markesbery WR, Jicha GA, Liu H, Schmitt FA. Lewy body pathology in normal elderly subjects. J Neuropathol Exp Neurol 2009;68:816-822.
  7. McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology 2017;89:88-100. 
  8. Ballard C, McKeith I, Burn D, Harrison R, O'Brien J, Lowery K, et al. The UPDRS scale as a means of identifying extrapyramidal signs in patients suffering from dementia with Lewy bodies. Acta Neurol Scand 1997;96:366-371.
  9. Voss T, Bahr D, Cummings J, Mills R, Ravina B, Williams H. Performance of a shortened Scale for Assessment of Positive Symptoms for Parkinson's disease psychosis. Parkinsonism Relat Disord 2013;19:295-299.
  10. Mosimann UP, Collerton D, Dudley R, Meyer TD, Graham G, Dean JL, et al. A semi-structured interview to assess visual hallucinations in older people. Int J Geriatr Psychiatry 2008;23:712-718.
  11. Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O'Brien JT, et al. The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale. Two methods to assess fluctuating confusion in dementia. Br J Psychiatry 2000;177:252-256.
  12. Lee DR, McKeith I, Mosimann U, Ghosh-Nodial A, Grayson L, Wilson B, et al. The dementia cognitive fluctuation scale, a new psychometric test for clinicians to identify cognitive fluctuations in people with dementia. Am J Geriatr Psychiatry 2014;22:926-935.
  13. Postuma RB, Arnulf I, Hogl B, Iranzo A, Miyamoto T, Dauvilliers Y, et al. A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study. Mov Disord 2012;27:913-916. 
  14. Stiasny-Kolster K, Mayer G, Schafer S, Moller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM sleep behavior disorder screening questionnaire--a new diagnostic instrument. Mov Disord 2007;22:2386-2393. 
  15. Ahn HJ, Chin J, Park A, Lee BH, Suh MK, Seo SW, et al. Seoul Neuropsychological Screening Batterydementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci 2010;25:1071-1076.
  16. Young PN, Estarellas M, Coomans E, Srikrishna M, Beaumont H, Maass A, et al. Imaging biomarkers in neurodegeneration: current and future practices. Alzheimers Res Ther 2020;12:49.
  17. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194. 
  18. McKeith IG, Ferman TJ, Thomas AJ, Blanc F, Boeve BF, Fujishiro H, et al. Research criteria for the diagnosis of prodromal dementia with Lewy bodies. Neurology 2020;94:743-755.
  19. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
  20. Jang H, Ye BS, Woo S, Kim SW, Chin J, Choi SH, et al. Prediction model of conversion to dementia risk in subjects with amnestic mild cognitive impairment: a longitudinal, multi-center clinic-based study. J Alzheimers Dis 2017;60:1579-1587.
  21. Ahn IS, Kim JH, Kim S, Chung JW, Kim H, Kang HS, et al. Impairment of instrumental activities of daily living in patients with mild cognitive impairment. Psychiatry Investig 2009;6:180-184. 
  22. Won CW, Rho YG, SunWoo D, Lee YS. The validity and reliability of Korean Instrumental Activities of Daily Living(K-IADL) Scale. J Korean Geriatr Soc 2002;6:273-280.
  23. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-35.
  24. Thomas AJ, Taylor JP, McKeith I, Bamford C, Burn D, Allan L, et al. Development of assessment toolkits for improving the diagnosis of the Lewy body dementias: feasibility study within the DIAMOND Lewy study. Int J Geriatr Psychiatry 2017;32:1280-1304.
  25. Galvin JE. Improving the clinical detection of Lewy body dementia with the Lewy body composite risk score. Alzheimers Dement (Amst) 2015;1:316-324.
  26. Kemp J, Philippi N, Phillipps C, Demuynck C, Albasser T, Martin-Hunyadi C, et al. Cognitive profile in prodromal dementia with Lewy bodies. Alzheimers Res Ther 2017;9:19.
  27. Oda H, Yamamoto Y, Maeda K. Neuropsychological profile of dementia with Lewy bodies. Psychogeriatrics 2009;9:85-90.
  28. McKeith I, O'Brien J, Walker Z, Tatsch K, Booij J, Darcourt J, et al.; DLB Study Group. Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. Lancet Neurol 2007;6:305-313.
  29. Yoshita M, Arai H, Arai H, Arai T, Asada T, Fujishiro H, et al. Diagnostic accuracy of 123I-meta-iodobenzylguanidine myocardial scintigraphy in dementia with Lewy bodies: a multicenter study. PLoS One 2015;10:e0120540.