Skip to main content

#PreventiveNeurology: misdiagnosis needs a solution

How are we going to get the general population to sign-up for screening for neurodegenerative diseases? #PreventiveNeurology 

Two of the three diseases we are targeting as part of our Preventive Neurology initiative will capture people with Diffuse Lewy Body (DLB) disease, i.e. Parkinson's disease and all-cause dementia. The BMJ commentary and DLB consensus report highlight the problem of misdiagnosis. If we are careful and embed in our prediction algorithms the right patient-related outcome measures and cognitive testing we should be able to identify a cohort of people with early DLB. May be this is wishful thinking. One of the obstacles we are going to find is getting members of the general population to sign-up for screening. Any ideas? 


Joseph Freer. UK lags far behind Europe on diagnosis of dementia with Lewy bodies. BMJ 2017;358:j3319

Excerpts:

..... Around half of UK patients who have dementia with Lewy bodies (DLB)—about 60 000 people—have it misdiagnosed, usually as the far more common Alzheimer’s disease, says the DLB Consortium in updated recommendations on diagnosing and managing DLB.

.... A survey of electronic health records of 500 patients in London, who met the criteria for a DLB diagnosis, showed that only 50% had the condition diagnosed and that only five people received the imaging that is now recommended during the diagnostic process.

.... DLB is much more common than previously thought, accounting for around 15% of dementia cases.

..... Misdiagnosis and underdiagnosis of DLB is a particular problem for patients in whom symptoms of psychosis and parkinsonism are common: patients with DLB who are treated with antipsychotics have an increased risk of mortality, as well as worsening parkinsonian symptoms. Patients with DLB also respond differently to medicines used commonly in Alzheimer’s disease and Parkinson’s disease.

McKeith et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology July 4, 2017 vol. 89 no. 1 88-100

The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.

Comments

Popular posts from this blog

#BrainHealth: another reason to hate margerine

Information rarely changes health outcomes on its own, which is why we need policy #PreventiveNeurology #BrainHealth
Although we have known about the cardiovascular risks associated with the consumption of trans fatty acids (TFAs) for decades little has been done by individuals to reduce their consumption. Therefore when the state of New York put in place restrictions on their use in 11 counties between 2007 and 2011 they set-up an experiment. This experiment now reports out: the study below included 25 counties and compared cardiovascular outcomes in the TFA non-restricted populations of 14 counties with the populations in the 11 TFA restricted counties. Three or more years after restrictions were put in place the people living in the counties with TFA restrictions experienced a significant decline in combined myocardial infarction and stroke events (-6.2%) compared with the TFA non-restricted populations. 

I sincerely hope you appreciate the significance of these findings? 

Lessons lea…

#BrainHealth: you are what you eat?

If you take #BrainHealth seriously you need to focus on diet.


Do you buy into 'you are what you eat'? This ambitious systematic literature review has identified 10 foods and 7 nutrients with evidence for causal cardio-metabolic effects. Any intervention that reduces your vascular risk burden should reduce all-cause dementia and improve your Brain Health. 

The foods that were found to have protective effects: fruitsvegetablesbeans/legumesnuts/seedswhole grainsfishyogurtfibreseafood omega-3spolyunsaturated fatspotassiumThe food found to have harmful effects:  unprocessed red meatsprocessed meatssugar-sweetened beveragesglycemic load (sugar or carbohydrates)trans-fatssodium/salt. There is nothing new here and most of this should be obvious to you and is currently included in mots dietary guidelines. The elephant in the room is economics; in modern economies people eat what they can afford. Modifying the nation's diet is going to need a rethink about how we encourage a healthy die…

#PredictPD: Is this the disease modifying therapy the PD community has been waiting for?

Is exenatide the game-changer we need in Parkinson's disease? #PreventiveNeurology #PredictPD
Would you participate in a study to define your future risk of getting Parkinson's Disease (PD)? In other words would you like to know you are likely to develop PD in the future? A lot of people answer by saying it depends if you have a treatment to prevent PD. At present we don't, but the study below of a exenatide,  a glucagon-like peptide-1 (GLP-1) receptor agonist, suggests it may be neuroprotective in patients with established PD. If this study's findings are confirmed in larger phase 3 studies and leads to exenatide being licensed as a disease-modifying therapy, or DMT, for PD changes all this. This means we can take people at high-risk of developing PD and randomise them to receive either placebo or exenatide to see if it can prevent, or at least delay the onset of, PD. This study alone creates the incentive for people from the general public to participate in population…