Three-minute rating scale identifies hard-to-diagnose form of dementia

By John Murphy, MDLinx
Published October 27, 2015

Key Takeaways

A new 3-minute test detects dementia in patients with Lewy body disease (LBD)—the second-most-common degenerative disease after Alzheimer’s disease. Although LBD affects more than 1.3 million Americans, it is poorly recognized and diagnosis is often significantly delayed.

Until now, there has been no standardized way to assess symptoms of LBD.

The new Lewy Body Composite Risk Score (LBCRS) is a brief rating scale that can quickly and effectively assess clinical signs and symptoms to diagnose LBD and Parkinson’s disease dementia (PDD) in about 3 minutes, according to its developer James E. Galvin, MD, MPH, a professor of clinical biomedical science at the Charles E. Schmidt College of Medicine at Florida Atlantic University, in Boca Raton, FL.

“Most patients never receive an evaluation by a neurologist skilled in the diagnosis of Lewy body dementia, and significant delays and misdiagnoses occur in most patients with this disease,” Dr. Galvin said. “This new tool has the potential to provide a clearer, more accurate picture for those patients who are unable to be seen by specialists, hastening the correct diagnosis, and reducing the strain and burden placed on patients and caregivers.”

The LBCRS is simple, 1-page assessment survey of 6 non-motor features present in patients with LBD, but found much less commonly in other forms of dementia. The clinician can use it to assess whether the patient has bradykinesia, rigidity, postural instability, or rest tremor without having to grade each extremity.

Another important aspect of the LBCRS is its ability to improve the sensitivity of diagnosis, thereby reducing the risk of exposure to patients with LBD to medications that can have potentially serious adverse consequences. The survey is intended to increase the potential for patients to receive appropriate and timely symptomatic therapies, and lessen the inappropriate exclusion from and inclusion into clinical trials.

Dr. Galvin and his team tested the LBCRS in comparison with the Clinical Dementia Rating and gold standard measures of cognition, motor symptoms, function, and behavior in a series of 256 patients in a “real world” clinic setting. Patients received the LBCRS after all other rating scales were scored and the diagnosis was presented to the patient and family.

Results showed that the LBCRS was able to discriminate LBD from Alzheimer’s with 96.8% accuracy, 90% sensitivity, and 87% specificity. The LBCRS study was published September 1, 2015 in Alzheimer’s & Dementia.

“Our study provides evidence-based methodology that will have applications in clinical practice, participation in clinical trials, prevention studies, community surveys, and biomarkers research,” Dr. Galvin said. “Early detection of Lewy body dementias will be important to enable future interventions at the earliest stages when they are likely to be most effective.”

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