Clinical Edge

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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.

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