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Attention and Fluctuating Attention in Patients With Dementia With Lewy Bodies and Alzheimer Disease
Clive Ballard, MRCPsych, MD;
John O'Brien, MRCPsych, DM;
Alistair Gray, BSc;
Franchesca Cormack, BSc;
Gareth Ayre, PhD;
Elise Rowan, PhD;
Peter Thompson, MRCPsych;
Romola Bucks, PhD;
Ian McKeith, FRCPsych, MD;
Matthew Walker, PhD;
Martin Tovee, PhD
Arch Neurol. 2001;58:977-982.
Background Attentional deficits are described in the consensus clinical criteria
for the operationalized diagnosis of dementia with Lewy bodies (DLB) as characteristic
of the condition. In addition, preliminary studies have indicated that both
attentional impairments and fluctuation of attentional impairments are more
marked in patients with DLB than in patients with Alzheimer disease (AD),
although neuropsychological function has not previously been examined in a
large prospective cohort with confirmed diagnostic accuracy against postmortem
diagnosis.
Methods A detailed evaluation of attention and fluctuating attention was undertaken
in 155 patients with dementia (85 with DLB and 80 with AD) from a representative
hospital dementia case register and 35 elderly controls using the Cognitive
Drug Research Computerized Assessment System for Dementia Patients computerized
neuropsychological battery. Operationalized clinical diagnosis was made using
the consensus criteria for DLB and the National Institute of Neurological
and Communicative Disorders and Stroke–Alzheimer's Disease and Related
Disorders Association criteria for AD. High levels of sensitivity and specificity
have been achieved for the first 50 cases undergoing postmortem examination.
Results The groups were well matched for severity of cognitive impairments,
but the AD patients were older (mean age, 80 vs 78 years) and more likely
to be female (55% vs 40%). Patients with DLB were significantly more impaired
than patients with AD on all measures of attention and fluctuating attention
(for all comparisons, t  2.5, P<.001), and patients from both dementia groups were significantly
more impaired than elderly controls for all comparisons other than cognitive
reaction time, which was significantly more impaired in DLB patients than
controls but was comparable in controls and AD patients. There were, however,
significant associations between the severity of cognitive impairment and
the severity of both attentional deficits and fluctuations in attention.
Conclusions This large prospective study confirms that slowing of cognitive processing,
attention, and fluctuations of attention are significantly more pronounced
in DLB and AD patients, although fluctuating attention is common in patients
with moderate-to-severe AD. Deficits of cognitive reaction time appear to
be specific to DLB, except in severe dementia. A detailed evaluation of attentional
performance could make an important contribution to differential diagnosis,
although the results need to be interpreted within the context of the overall
severity of cognitive deficits.
From the Institute for the Health of the Elderly, Wolfson Research
Centre, Newcastle General Hospital (Drs Ballard, O'Brien, Rowan, and McKeith),
and Department of Psychology, University of Newcastle Upon Tyne (Mr Gray,
Ms Cormack, and Dr Tovee), Newcastle, England; CDR Limited, Reading, England
(Dr Ayre); Bensham Hospital, Gateshead, England (Dr Thompson); Blackberry
Hill Hospital, Bristol, England (Dr Bucks); and Harvard University, Boston,
Mass (Dr Walker).
Corresponding author and reprints: Clive Ballard, MRCPsych, MD, Institute
for the Health of the Elderly, Wolfson Research Centre, Newcastle General
Hospital, Westgate Road, Newcastle, England NE4 6BE (e-mail: c.g.ballard{at}ncl.ac.uk).
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