Lewy Body Disease: Clinical and Pathological “Overlap Syndrome” Between Synucleinopathies (Parkinson Disease) and Tauopathies (Alzheimer Disease)
Lewy body disease (LBD) is a neurodegenerative disease resulting in dementia. It shares clinical and pathological features with Parkinson disease (PD), the most frequent synucleinopathy, Parkinson disease dementia (PDD), and Alzheimer disease (AD), a tauopathy. Even though the diagnostic criteria for these neurodegenerative diseases are clearly established, and recently revised for LBD, their precise clinical diagnosis is often difficult because LBD, PD, PDD, and AD share epidemiological, clinical, and pathological characteristics. This manuscript discusses current understanding of overlapping symptoms and the particular features of LBD, PD, and AD. It also describes features that could facilitate the diagnosis of each of these diseases. We concluded that the concept of neurodegenerative “overlap” syndrome, which includes the accepted diagnosis of LBD, may be taken in account and should contribute to clarifying LBD and definitions of close differential diagnoses. This should allow clinicians to suspect LBD at an earlier stage and provide better patient care.
KeywordsAlzheimer disease Lewy body disease Overlapping syndrome Parkinson disease
The authors are grateful to Mr. Philip Bastable and Dr. B. Kamsu-Foguem.
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Conflict of Interest
Clovis Foguem and Patrick Manckoundia declare no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 4.•• Foguem C, Kamsu-Foguem B. Neurodegeneration in tauopathies and synucleinopathies. Rev Neurol (Paris). 2016;172(11):709–14. Foguem and Kamsu-Foguem described the physiopathology (accumulation of one or more aggregated proteins as the molecular signature) of the three main disease groups constituting the majority of neurodegenerative diseases as tauopathies (Alzheimer’s disease), alpha-synucleinopathies (Parkinson’s disease) and diseases due to repetitions of glutamine (Huntington’s disease). They suggested that in the future, innovative strategies to elaborate suitable diagnostic and therapeutic approaches for neurodegenerative diseases would be found.CrossRefGoogle Scholar
- 13.Waters CH. Lewy body disease: diagnosis and management of Parkinson’s disease. Prof Commun. 2008:76–7.Google Scholar
- 18.Ferchichi S, Giraud M, Smagghe A. La démence à corps de Lewy. Rev Gériatr. 2000;25(7):493–8.Google Scholar
- 24.•• Peelaerts W, Bousset L, Van der Perren A, Moskalyuk A, Pulizzi R, Giugliano M, et al. α-Synuclein strains cause distinct synucleinopathies after local and systemic administration. Nature. 2015;522(7556):340–4. Peelaerts et al. studies misfolded protein aggregates which represent a continuum with overlapping features in neurodegenerative diseases, but differences in protein components and affected brain regions. They demonstrated that distinct α-SYN strains display differential seeding capacities, inducing strain-specific pathology and neurotoxic phenotypes.CrossRefPubMedGoogle Scholar
- 31.Rolinski M, Fox C, Maidment I, McShane R. Cholinesterase inhibitors for Lewy body disease, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database Syst Rev. 2012;3:CD006504.Google Scholar
- 32.Aarsland D, Litvan I, Salmon D, Galasko D, Wentzel-Larsen T, Larsen JP. Performance on the dementia rating scale in Parkinson’s disease with dementia and Lewy body disease: comparison with progressive supranuclear palsy and Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2003;74(9):1215–20.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Vieira RT, Caixeta L, Machado S, Caxeita M. Dementia in Parkinson’s disease: a clinical review. Am J Neurosci. 2011;2(1):35–47.Google Scholar
- 40.Bibl M, Esselmann H, Lewczuk P, Trenkwalder C, Otto M, Kornhuber J, et al. Combined analysis of CSF tau, Aβ42, Aβ1–42% and Aβ1–40% in Alzheimer’s disease: Lewy body disease and Parkinson’s disease dementia. Int J Alzheimers Dis. 2010.Google Scholar
- 41.Blennow K, Hampel H. CSF markers for incipient Alzheimer’s disease. Lancet Neurol 2003; 2 (10): 605–613.Google Scholar
- 44.Lee JE, Park HJ, Park B, Song SK, Sohn YH, Lee JD, et al. A comparative analysis of cognitive profiles and white-matter alterations using voxel-based diffusion tensor imaging between patients with Parkinson's disease dementia and Lewy body disease. J Neurol Neurosurg Psychiatry. 2010;81(3):320–6.CrossRefPubMedGoogle Scholar
- 46.• Han D, Wang Q, Gao Z, Chen T, Wang Z. Clinical features of Lewy body disease in 35 Chinese patients. Transl Neurodegener. 2014;3(1):1. Han et al., through a meta-analyses of 18 studies, investigate the clinical features of dementia with Lewy bodies (DLB) in a Chinese population. They found dementia, fluctuating cognition, recurrent visual hallucinations, and spontaneous features of Parkinsonism as DLB clinical core features. Neuropsychological, neuroimaging, and EEG examinations may improve the diagnostic accuracy and discriminate DLB from other dementias.CrossRefPubMedPubMedCentralGoogle Scholar