Recognition of dementia with Lewy bodies. Prevalence of core signs, medical treatments and survival in Swedish nursing homes and short-term homes.

Dementia with Lewy bodies (DLB) is an underdiagnosed neurocognitive disorder thatincludes several complex neurological and psychological signs, which are challenging toclinical diagnostics. The recognition of this neurocognitive disorder should beimproved because people with DLB exhibit a good treatment response to anti-dementiamedications but experience severe adverse events if treated with anti-psychoticmedicine.The main aim of this thesis was to investigate the prevalence of DLB core signs andmedical treatments among older adults living in nursing homes (NHs) and short-termNHs in an entire Swedish city. A second aim was to compare the survival betweenresidents of NHs with 0–1 and 2–4 DLB core signs.Design: For all papers, I applied a specially designed form covering all four core DLBsigns. This form was administered to residents of 40 NHs (N=650, mean age 86 years,75% women) in 2012–2013 and to residents of three short-term NHs (N=141, meanage 83 years, 63% women) in 2018. The registered nurse at each NH/short-term NHcompleted the form and collected the study data, including medication lists. For PaperIV, data were obtained from short-term NHs, and the participating residents (N=112)were given a medical examination by physicians.Results: In Paper I, we found a prevalence of 2–4 DLB core signs in 16–20% of all610 NH residents. In Paper II, analysis of the rates of treatment with psychotropicsshowed use of anti-psychotics by 23% of residents, hypnotics/sedatives by 41% andanti-dementia medications by 33% of the entire study population. Use of antipsychoticsincreased from 25% to 43% in residents with an increasing number of DLBcore signs. In Paper III, the mean survival differed between residents according to thenumber of DLB signs; those with 0–1 DLB signs lived 8 months longer than thosewith 2–4 DLB signs. In Paper IV, we found a prevalence of 2–4 DLB core signs in32% of all short-term NH residents.Conclusion: In both NHs and short-term NHs, 16–32% of residents had 2–4 DLBcore signs. These “high-risk DLB residents” also received unfavourable medicaltreatment, as shown by the high use of anti-psychotic medicine and shorter survivalcompared with residents with 0–1 DLB core signs