Subtypes of Dementia with Lewy Bodies: Clinical Features, Survival, and Apolipoprotein E Effect.

Background: Dementia with Lewy bodies (DLB) is a progressive neurodegenerative disease with various clinical symptoms. Limited data have described the clinical subtypes of DLB.

Objective: We aimed to compare clinical subtypes of DLB according to initial symptoms and to study the effect of Apolipoprotein E () gene in DLB.

Methods: We included DLB patients classified into three groups based on initial symptoms: non-motor onset (cognitive and/or psychiatric) (NMO-DLB), motor onset (parkinsonism and/or gait disorders) (MO-DLB), and mixed onset (non-motor and motor symptoms) (MXO-DLB). Clinical and genotype associations and survival were analyzed.

Results: A total of 268 patients were included (NMO-DLB = 75%, MXO-DLB = 15.3%, MO-DLB = 9.7%). Visual hallucinations were more frequent ( = 0.025), and attention was less commonly impaired in MXO-DLB ( = 0.047). When adjusting with 4 status ( genotype performed in 155 patients), earlier falls and frontal lobe syndrome were more common in MXO-DLB ( = 0.044 and = 0.023, respectively). The median MMSE decline was 2.1 points/year and the median FAB decline was 1.9 points/year, with no effect of clinical subtypes. Median survival was 6 years. It was similar in DLB subtypes ( = 0.62), but shorter for patients with memory symptoms at onset ( = 0.04) and for males ( = 0.0058).

Conclusions: Our study revealed a few differences between DLB clinical subtypes. 4 appears to be associated with earlier falls and a higher prevalence of frontal syndrome in MXO-DLB. However, DLB clinical subtypes did not impact on survival. Nevertheless, survival analysis identified other poor prognosis factors, notably inaugural memory impairment and male gender.