Different abnormalities of electroencephalographic (EEG) markers in quiet wakefulness are related to motor visual hallucinations in patients with Parkinson's and Lewy body diseases

AbstractBackgroundParkinson's disease (PD) is the second‐most common neurodegenerative disorder that affects 2–3% of the population ≥ 65 years of age and may belong to cognitive deficits and dementia in 50% of cases. Disease with Lewy Bodies (DLB) is emerging as another important cause of dementia in pathological aging. PD and DLB are both due to intra‐neuronal Lewy bodies and are characterized not only by motor dysfunctions but also by cognitive and/or psychiatric symptoms. An open issue is the extent to which these diseases are distinct entities. In this respect, here we compared cortical sources of resting state eyes‐closed electroencephalographic (rsEEG) rhythms in PD and DLB patients having visual hallucinations.MethodClinical and rsEEG rhythms in demographic matched PD (N = 93), DLB (N = 46), Alzheimer's disease dementia (AD, N= 70) and healthy elderly (Nold, N = 60) subjects were available from an international archive. Pathological groups were matched for cognitive status. Individual alpha frequency peak was used to determine the delta, theta, alpha1, alpha2, and alpha3 frequency band ranges. Fixed beta1, beta2, and gamma bands were considered. The eLORETA freeware estimated rsEEG cortical sources.ResultAs a confirmation of previous studies, compared to the Nold subjects, the AD, LBD, and PD patients showed higher widespread delta source activities and lower posterior alpha source activities. Specifically, posterior alpha source activities were more abnormal in the AD than the LBD and PD groups, while widespread delta source activities were more abnormal in the PD and DLB than the AD group. As novel results, in relation to the LBD and PD patients without visual hallucinations and the control groups (Nold, AD), those with visual hallucinations were characterized by higher parietal delta source activities (LBD, Figure 1) and parieto‐occipital alpha sources activities (PD, Figure 2).ConclusionThese novel results suggest that in LBD and PD patients resting in the quiet wakefulness, abnormalities in cortical neural synchronization at delta and alpha frequencies in parietal cortex are differently related to visual hallucinations despite the essence of alpha‐synucleinopathy

Functional cortical source connectivity of resting state electroencephalographic alpha rhythms shows similar abnormalities in patients with mild cognitive impairment due to Alzheimer's and Parkinson's diseases

Objective: This study tested the hypothesis that markers of functional cortical source connectivity of resting state eyes-closed electroencephalographic (rsEEG) rhythms may be abnormal in subjects with mild cognitive impairment due to Alzheimer's (ADMCI) and Parkinson's (PDMCI) diseases compared to healthy elderly subjects (Nold). Methods: rsEEG data had been collected in ADMCI, PDMCI, and Nold subjects (N = 75 for any group). eLORETA freeware estimated functional lagged linear connectivity (LLC) from rsEEG cortical sources. Area under receiver operating characteristic (AUROC) curve indexed the accuracy in the classification of Nold and MCI individuals. Results: Posterior interhemispheric and widespread intrahemispheric alpha LLC solutions were abnormally lower in both MCI groups compared to the Nold group. At the individual level, AUROC curves of LLC solutions in posterior alpha sources exhibited moderate accuracies (0.70-0.72) in the discrimination of Nold vs. ADMCI-PDMCI individuals. No differences in the LLC solutions were found between the two MCI groups. Conclusions: These findings unveil similar abnormalities in functional cortical connectivity estimated in widespread alpha sources in ADMCI and PDMCI. This was true at both group and individual levels. Significance: The similar abnormality of alpha source connectivity in ADMCI and PDMCI subjects might reflect common cholinergic impairment. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved

P3‐209: Impact of Biomarkers On Diagnostic Confidence in Clinical Assessment of Patients with Suspected Alzheimer's Disease and High Diagnostic Uncertainty: An EADC Study

Background: NIA-AA and IWG diagnostic criteria for Alzheimer's Disease (AD) include core structural, functional, and CSF biomarkers. The impact of core biomarkers in clinical settings is still unclear. This study aimed at measuring the impact of core biomarkers on the diagnostic confidence of uncertain AD cases in a routine memory clinic setting. // Methods: 356 patients with mild dementia (MMSE = 20) or Mild Cognitive Impairment possibly due to AD were recruited in 17 European Alzheimer's Disease Consortium (EADC) memory clinics. The following variables were collected: age; sex; MMSE; neuropsychological evaluation including long term memory, executive functions, language and visuospatial abilities. Core biomarkers were collected following local practices: Scheltens’s visual assessment of medial temporal atrophy (MTA) on MR scan; visual assessment of hypometabolism/hypoperfusion on FDG-PET/SPECT brain scan; CSF Aß1-42, tau and phospho-tau levels. At diagnostic workup completion, an estimate of confidence that cognitive complaints were due to AD was elicited from clinicians on a structured scale ranging from 0 to 100. Only cases with uncertain diagnoses (confidence between 15% and 85%) were retained for analysis. Generalized linear models were used to describe the relationship between the collected measures and the diagnostic confidence of AD. // Results: Neuropsychological assessment was carried out in almost all cases (98% of the cases). Medial temporal atrophy ratings were done in 40% of cases, assessment of cortical hypometabolism/hypoperfusion in 34%, and CSF Aß and tau levels in 26%. The markers that better explained the variability of diagnostic confidence were CSF Aß1-42 level (R2=0.46) and hypometabolism/hypoperfusion (R2=0.45), followed by CSF tau level (R2=0.35), MTA assessment (R2=0.32) and. All figures were highly significant, at p<<0.001. The diagnostic confidence variability due to neuropsychological tests for different domains was lower: MMSE (R2=0.29); long term memory (R2=0.23); executive functions (R2=0.05); language (R2=0.02); visuospatial abilities (R2=0.04) even if significant (p<0.01). // Conclusions: The use of core biomarkers in the clinical assessment of subjects with suspected AD and high diagnostic uncertainty is still limited. However, when assessed, these biomarkers show a higher impact on diagnostic confidence of AD than the most widespread clinical measures

Sleep profiles in patients with alzheimer's disease and dementia with lewy bodies

Amaç: Alzheimer hastaları, Lewy Cisimli Demans (LCD) hastaları ve sağlıklı kontroller öznel uyku kalitesi, uyku bozuklukları ve aşırı gündüz uykululuğu açısından karşılaştırılmıştır. Uyku bozuklukları ve aşırı gündüz uykululuğunun demans şiddetine bağımlı olup olmadığı araştırılmıştır. Yöntem: 85 sağlıklı kontrol, 84 Alzheimer hastası ve 31 LCD hastasının uyku profilleri Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ve Epworth Uykululuk Ölçeği (EUÖ) kullanılarak değerlendirilmiştir. Mini Mental Durum Testi ve Klinik Demans Evrelendirme Ölçeği, Alzheimer ve LCD hastalarının demans şiddetini belirlemek ve sağlıklı kontrollerin demans olasılığını dışlamak için kullanılmıştır. Bulgular: Alzheimer ve LCD hastaları, sağlıklı kontrollerle karşılaştırıldığında daha kötü uyku kalitesi ve daha fazla uyku bozukluğu bildirmiştir. Aşırı gündüz uykululuğu da sağlıklı kontrollerle karşılaştırıldığında Alzheimer ve LCD hastalarında daha sık bildirilmiştir. Alzheimer ve LCD hastaları arasında uyku kalitesi ve aşırı gündüz uykululuğu açısından istatistiksel olarak anlamlı fark bulunmamıştır. PUKİ'de tek bir item olan, `Kötü rüyalar görme' LCD hastalarında Alzheimer hastaları ve sağlıklı kontrollerle karşılaştırıldığında daha sık bulunmuştur. Uyku bozuklukları ve aşırı gündüz uykululuğu ile hastaların demans şiddeti arasında istatistiksel olarak fark bulunmamıştır. Sonuç: İki hasta grubu da belirgin düzeyde uyku bozukluğu bildirmiştir. Kötü uyku kalitesi ve aşırı gündüz uykululuğu sağlıklı kontrollerle karşılaştırıldığında Alzheimer ve LCD hastalarında daha yaygındır. Objective: We compared subjective sleep quality, sleep disturbances and excessive daytime somnolence (EDS) in non-demented elderly, Alzheimer?s disease (AD) and dementia with Lewy bodies (DLB). We investigated whether sleep dysfunction and EDS associate with the severity of dementia. Method: The sleep profiles of 85 non-demented elderly, 84 patients with AD and 31 with DLB were assessed using two questionnaires, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). In order to evaluate the severity of dementia in patients with AD and DLB and to determine the non-demented elderly, Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR) were used. Results: AD and DLB patients had worse sleep quality and more sleep disturbances when compared to non-demented elderly. EDS was also more frequent in AD and DLB patients than in non-demented elderly. There were no significant difference between AD and DLB patients in terms of sleep quality or EDS. Having bad dreams -single item on PSQI- was more frequent in DLB patients when compared with AD and non-demented elderly. Sleep dysfunction and EDS were not associated with the severity of dementia. Conclusion: Both patient groups have extensive sleep problems. Poor sleep quality and EDS are greater in AD and DLB patients compared with control