Effects of white matter hyperintensities, neuropsychiatric symptoms, and cognition on activities of daily living: Differences between Alzheimer's disease and dementia with Lewy bodies

Saira Saeed Mirza; Usman Saeed; Joel Ramirez; Nathan Herrmann; Donald T Stuss; Sandra E Black; Mario Masellis

doi:10.1002/dad2.12306

Effects of white matter hyperintensities, neuropsychiatric symptoms, and cognition on activities of daily living: Differences between Alzheimer's disease and dementia with Lewy bodies

Alzheimers Dement (Amst). 2022 May 2;14(1):e12306. doi: 10.1002/dad2.12306. eCollection 2022.

Authors

Saira Saeed Mirza^{1

2}, Usman Saeed³, Joel Ramirez^{2

3

4}, Nathan Herrmann^{2

5}, Donald T Stuss⁶, Sandra E Black^{1

2

3

4}, Mario Masellis^{1

2

3}

Affiliations

¹ Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.
² Hurvitz Brain Sciences Research Program Sunnybrook Research Institute University of Toronto Toronto Ontario Canada.
³ LC Campbell Cognitive Neurology Research Unit Sunnybrook Research Institute University of Toronto Toronto Ontario Canada.
⁴ Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada.
⁵ Department of Psychiatry Faculty of Medicine University of Toronto Toronto Ontario Canada.
⁶ Department of Psychology, Faculty of Arts and Science Department of Medicine (Neurology) Faculty of Medicine University of Toronto Toronto Ontario Canada.

Abstract

Introduction: Disability is common across Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). White matter hyperintensities (WMHs) are prevalent in both diagnoses and associated with disability; both diagnoses show neuropsychiatric symptoms (NPS) and impaired cognition.

Methods: In AD and DLB, we examined if WMHs, NPS, and cognition associate with basic and/or instrumental activities of daily living (BADLs and/or IADLs) cross-sectionally, and longitudinally over ≈1.4 years.

Results: Across both diagnoses, NPS were not only associated with greater disability in performing both BADLs and IADLs, but were also associated with a decline in the ability to perform BADLs in the AD group. In the DLB group only, higher WMH volume was associated with greater disability in performing both BADLs and IADLs, and was associated with a decline in the ability to perform BADL over time.

Discussion: Management of NPS and WMHs, particularly in DLB, might help maintain functionality in dementia patients for longer.

Keywords: Alzheimer's disease and dementia with Lewy bodies; activities of daily living; neuropsychiatric symptoms; white matter hyperintensities.