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Familial Occurrence of Dementia With Lewy Bodies

Received April 14, 2003; revised June 2, September 17, 2003; accepted September 24, 2003. From the Departments of Psychiatry and Behavioral Sciences (DWT,TDB), Neurology (TDB), and Medical Genetics (TDB), University of Washington, Seattle, WA; the Mental Illness Research, Education, and Clinical Center (DWT,LD), and the Geriatric Research, Education, and Clinical Center (TDB), VA Puget Sound Health Care System, Seattle, WA. Send correspondence to Debby Tsuang, M.D., M.Sc., VAPSHCS (116-MIRECC), 1660 South Columbian Way, Seattle, WA 98108. e-mail: dwt1{at}u.washington.edu
© 2004 American Association for Geriatric Psychiatry

Objective: The authors investigated the validity of the designation "familial dementia with Lewy bodies (DLB)" by evaluating the clinical, neuropathological, and genetic characteristics of previously reported families exhibiting both familial parkinsonism and dementia. Methods: Several families, including multiple individuals with parkinsonism as well as prominent dementia, were identified through a literature search. Selected families had at least one member with dementia with autopsy evidence of neocortical and/or limbic Lewy-body (LB) pathology. Clinical and neuropathological evidence from reports of families with prominent dementia as well as parkinsonism was reviewed to further define familial DLB. Results: All selected families had at least one affected individual with dementia and autopsy-proven DLB. Therefore, these families might be considered examples of familial DLB. Individuals in the first six families typically presented with parkinsonian features, whereas cognitive decline did not appear until years later. In contrast, in the other six families, affected individuals typically presented with cognitive decline, and parkinsonism developed later. Conclusions: Families exist in which one or more persons meet both clinical and neuropathological criteria for DLB. They differ as to whether the signs of parkinsonism precede or follow signs of dementia. It remains to be determined whether this clinical distinction is biologically important. Susceptibility to developing LB pathology may be determined by the interaction between genetic predisposition and environmental risk factors.

Key Words: Genetics • Lewy-Body Dementia • Parkinson Disease

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