Design: 308 nursing home patients were prospectively evaluated every 6 months from 1987-93 (diagnosis, mini mental status MMS, ADL score, involuntary events and extrapyramidal symptom scale, and prescription of neuroleptics).
Materials and Methods: Of these, 137 had a brain autopsy performed and an immunohistochemical examination of temporal, parietal, and frontal cortex, according to the consensus criteria of the McKeith criteria for Lewy Body Dementia (LBD). The clinical diagnostic criteria were used for a retrospective chart analysis by a geriatrician blind to the histopathological results.
Results: 16 of the 111 patients with dementia had a pathological diagnosis of LBD. The McKeith clinical diagnostic criteria showed a sensitivity of 0.38 and a specificity of 0.93. The rate of cognitive deterioration was highest in cases with LBD (-4.7 pt in MMS/6months) in comparison to patients with Alzheimer's disease (-1.6 pt/6months) or other dementias (-1.3 pt/6months). The extrapyramidal symptoms showed only moderate deterioration in LBD but moderate to severe worsening in most Alzheimer’s patients.
Conclusion: Patients with LBD had the highest average neuroleptic doses (38 mg chlorpromazine equivalents/d for LBD and 22 mg for Alzheimer dementia). Men with neuroleptics and LBD had a dose-dependent shortening of survival, which was not observed in women.
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