Cognitive decline in dementia with Lewy bodies: a 5-year prospective cohort study

Rongve, A. et al. BMJ Open 2016;6:e010357

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Image source: Jensflorian

Image shows autopsy case of Lewy body dementia showing eosinophilic neuronal inclusions

Objectives: We report the cognitive decline in persons diagnosed with mild dementia with Lewy bodies (DLB) and mild Alzheimer’s disease (AD) during 5 years of annual follow-ups.

Methods: Patients were recruited into the study from geriatric, psychiatric and neurology clinics in Western Norway during 2005–2013. They were diagnosed according to clinical consensus criteria, based on standardised clinical rating scales. Autopsy-based diagnoses were available for 20 cases. Cognitive decline for up to 5 years was assessed using the Clinical Dementia Rating (CDR) scale and the Mini-Mental State Examination (MMSE). Survival analysis including Cox regression (time to reach severe dementia) and linear mixed-effects (lme) modelling were used to model the decline on MMSE.

Results: At least one follow-up assessment was available for 67 patients with DLB and 107 patients with AD, with a median follow-up time of 4.3 years. The time to reach severe dementia was significantly shorter in DLB (median 1793 days) compared with AD (1947 days; p=0.033), and the difference remained significant in the multiple Cox regression analysis (HR=2.0, p<0.02). In the adjusted lme model, MMSE decline was faster in DLB (annual decline 4.4 points) compared with AD (3.2 points; p<0.008).

Conclusions: Our findings show that from the mild dementia stage, patients with DLB have a more rapid cognitive decline than in AD. Such prognostic information is vital for patients and families and crucial for planning clinical trials and enabling health economic modelling.

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Could music projects cut the cost of dementia care?

By Pugh, R. for the Guardian Social Care Network. Published 29th February 2016.

C0030793 Saxophone
Image source: Wellcome Library

Sheer embarrassment was dementia care worker Lynda Kelly’s overwhelming emotion the first time she sat in on a Manchester Camerata orchestra music therapy session at the residential home where she works; but the lasting change she saw in the residents in response to the musicians was so great that she is now running weekly improvisation sessions at the home.

Kelly, the activities coordinator for Acacia Lodge – a 60-bed residential home in New Moston, Manchester – reports seeing a mute female resident with advanced Alzheimer’s sing Swing Low, Sweet Chariot at top volume with all the words in one of the first Camerata sessions. Two other former non-speakers now communicate with staff as though they had never stopped and many more display greater confidence, increased activity levels and more cooperation with their carers.

“The first music session I went to, I did not know where to put myself with embarrassment – I was not used to seeing people sing and express themselves like that,” says Kelly, who has since then been involved in three music and dementia projects with the chamber orchestra over the past three years, including a 10-week course for Acacia Lodge residents. “But the impact has been amazing and I realised within two weeks that music was getting to them in a completely different way.”

Manchester Camerata orchestra’s Music in Mind (MIM) projects, which involved 7,200 people in care homes and community projects across Greater Manchester last year, have had such dramatic effects on participants that academics at Manchester and Lancaster universities are backing a research student to create the world’s first in-the-moment, multi-sensory assessment tool to quantify that effect.

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