The Neuropsychiatric Symptom Profile of Mild Dementia With Lewy Bodies

Introduction Neuropsychiatric symptoms are often considered late manifestations of dementia and can be neglected during early clinical assessments. Besides visual hallucinations, less is known about other neuropsychiatric symptoms in mild dementia with Lewy bodies (DLB). We aimed to 1) describe neuropsychiatric symptoms and associated caregiver distress in mild DLB; 2) describe neuropsychiatric symptoms stratified by dementia stage within the included participants. Methods Individuals with probable DLB and their caregivers underwent clinical and neuropsychiatric assessments. Clinical Dementia Rating Global Score (CDR-G) of 0.5 (denoting “very mild dementia”) was used to stratify the participants into earlier and later stage subgroups. The Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms. Median regression was used to estimate the difference in symptom severity and caregiver distress between the subgroups. Results Fifty participants (age 73.5 ± 5.7 years, 43 males, median mini mental state exam (MMSE) 26 IQR 23 - 27, median CDR 0.5 IQR 0.5 - 1) were enrolled. Twenty-six had earlier and 24, later stage dementia. Neuropsychiatric symptoms were common across both subgroups (96.2% and 95.8% prevalence respectively), with apathy, anxiety and depression being most prevalent (≥50% prevalence). Overall symptom severity was similar between the subgroups, although caregivers of the later stage subgroup reported more distress. Conclusion Neuropsychiatric symptom, especially apathy, anxiety and depression, are extremely common in mild DLB. Assessment of neuropsychiatric symptoms is therefore an essential part of clinical care in DLB, starting from initial presentation. Future studies should consider factors other than symptom severity that contribute to caregiver distress.