Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Excessive Daytime Sleepiness: Early Feature of DLB

Parkinsonism Relat Disord; 2018 May; Kasanuki, et al

Excessive daytime sleepiness in early dementia with Lewy bodies (DLB) is indicative of a more profound loss of basal forebrain cholinergic integrity, a recent study found. Autopsy-confirmed patients, who met clinical criteria for probable DLB at their initial evaluation and who were administered the informant-completed Epworth Sleepiness Scale, were included in the study (n=40). Each patient had a dementia at baseline (80% with mild severity) and ≥2 features of parkinsonism, visual hallucinations, fluctuations, or probable REM sleep behavior disorder. Quantitative digital pathology of the nucleus basalis of Meynert was performed in the DLB group and in 20 non-DLB autopsy controls. Researchers found:

  • DLB had greater neuronal depletion in the nucleus basalis of Meynert than pathologic controls.
  • Sleepiness was present in 58% of the DLB group and those with daytime sleepiness had significantly lower neuron counts in the nucleus basalis of Meynert than their non-sleepy counterparts.
  • Regression modeling revealed that sleepiness was a stronger predictor of neuronal loss in the nucleus basalis of Meynert than visual hallucinations, fluctuations, or dementia severity.

Citation:

Kasanuki K, Ferman TJ, Murray ME, et al. Daytime sleepiness in dementia with Lewy bodies is associated with neuronal depletion of the nucleus basalis of Meynert. Parkinsonism Relat Disord. 2018;50:99-103. doi:10.1016/j.parkreldis.2018.02.003.

This Week's Must Reads

Stroke Care Comparison of Asian Americans and Whites, JAMA Neurology; ePub 2019 Jan 22; Song, Liang, et al

Aerobic Exercise Can Improve Executive Functioning , Neurology; 2019 Jan 15; Blumenthal, et al

Episodic Memory Decline is Neurodegenerative Marker, Neurology; ePub 2019 Jan 23; Wilson, Yang, et al

Serum Troponin Level Marker for Visceral Infarcts , J Stroke Cerebrovasc Dis; ePub 2019 Jan 18; Azher, et al

Urine Sodium-to-Potassium Ratio Predicts Stroke, Stroke; ePub 2019 Jan 21; Averill, Young, et al

Must Reads in Movement Disorders

Tourette, CTD, and Cardiometabolic Disorders Link, JAMA Neurology; ePub 2018 Jan 14; Brander, et al

Study Compares 2 Cognitive Assessment Tools, Mov Disord; ePub 2018 Dec 10; Hendershott, et al

White Matter Differences Between ET and PD, Neurology; ePub 2018 Nov 30; Juttukonda, et al

Physical Activity and Clinical Progression in PD, Parkinsonism Relat Disord; ePub 2018 Dec 10; Amara, et al

Analyzing the Spectrum of Visual Symptoms in PD , Front Neurol; ePub 2018 Nov 27; Barrell, et al