Major Depression As Initial Manifestation Of Limbic Lewy Body Dementia A Clinico-Pathological Report (P2.155)

Abstract

OBJECTIVE: Describe early behavioral (emotional) manifestations of Lewy Body Dementia (LBD). BACKGROUND: REM sleep behavior disorders, visuo-spatial, attention and executive dysfunction have been proposed to define very early stages of LBD (Boeve B. 2012), suggesting that differentiating LBD vs. AD, in the MCI phase, will be feasible. An atypical autopsy case of LBD, with clinically diagnosed major depression, have been reported (Iritani S. et al., 2008). Depression is only listed as a non specific manifestation of DLDB in International Criteria (Mc Keith I.G. et al., 2006). DESIGN/METHODS: Among a neuropathology series of 9 cases of synucleinopathies, we observed a patient (63 years old) in which major depression was the prominent initial symptom of the disease. Hallucinations appeared 1 year (favored by tricyclic antidepressant) and dementia with parkinsonism and delusion, 3 years after the first depressive symptoms (case N°6). RESULTS: Neuropathological examination was performed 7 years after the onset of the disease, with specific immunolabeling antibodies (α-synucleïn, AAP, Tau, GFAP) and neuronal loss counting, centered in specific regions of interest: frontal, occipital neocortex, Meynert’s Nucleus, hippocampus and Amygdala, and in limbic cortex, locus Niger, Locus coeruleus and bulbar nuclei in brainstem, basal ganglia and cerebellum. It underlines the prominent α-synucleïn labelled lesions (LB and Threads) in Amygdala, of this characteristic limbic form of DLB. CONCLUSIONS: Major depression can be an early clinical manifestation, at MCI stage, of limbic form of DLB. It needs to be recognized by clinician, with specific neuropsychological evaluation (attention, visuo-spatial and dysexecutive tasks). Study Supported by:

Disclosure: Dr. Michel has nothing to disclose. Dr. Becker has nothing to disclose. Dr. Pelissier has nothing to disclose. Dr. Boeve has received research support from Cephalon, Inc., Allon Therapeutics, and GE Healthcare. Dr. Sambuchi has nothing to disclose. Dr. Bartolin has nothing to disclose. Dr. Gallant has nothing to disclose. Dr. Saint Jean has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Rouyer has nothing to disclose. Dr. Azorin has nothing to disclose. Dr. Petersen has received personal compensation for activities with Pfizer, Inc., and Janssen Alzheimer's Immunotherapy. Dr. Petersen has received royalty payments from Oxford University Press.