Risk factors for dementia with Lewy bodies: A case-control study

Neurology. 2013 Jul 26. [Epub ahead of print]

Boot BP, Orr CF, Ahlskog JE, Ferman TJ, Roberts R, Pankratz VS, Dickson DW, Parisi J, Aakre JA, Geda YE, Knopman DS, Petersen RC, Boeve BF.

Source

From the Departments of Neurology (B.P.B, C.F.O., J.E.A., Y.E.G., D.S.K., R.C.P., B.F.B.), Psychiatry and Psychology (T.J.F., Y.E.G.), Health Sciences Research (R.R., V.S.P., J.A.A., Y.E.G.), Anatomic Pathology (D.W.D.), and Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program of the Mayo Foundation (B.P.B., C.F.O., Y.E.G., D.S.K., R.C.P., B.F.B.), Mayo Clinic College of Medicine, Rochester MN, Scottsdale, AZ, and Jacksonville FL. B.P.B. is currently affiliated with the Neurology Department, Brigham and Women's Hospital, Boston, MA. C.F.O. is currently affiliated with Macquarie Neurology, Macquarie University Hospital, NSW, Australia.

Abstract

OBJECTIVE:

To determine the risk factors associated with dementia with Lewy bodies (DLB).

METHODS:

We identified 147 subjects with DLB and sampled 2 sex- and age-matched cognitively normal control subjects for each case. We also identified an unmatched comparison group of 236 subjects with Alzheimer disease (AD). We evaluated 19 candidate risk factors in the study cohort.

RESULTS:

Compared with controls, subjects with DLB were more likely to have a history of anxiety (odds ratio; 95% confidence interval) (7.4; 3.5-16; p < 0.0001), depression (6.0; 3.7-9.5; p < 0.0001), stroke (2.8; 1.3-6.3; p = 0.01), a family history of Parkinson disease (PD) (4.6; 2.5-8.6; p < 0.0001), and carry APOE ε4 alleles (2.2; 1.5-3.3; p < 0.0001), but less likely to have had cancer (0.44; 0.27-0.70; p = 0.0006) or use caffeine (0.29; 0.14-0.57; p < 0.0001) with a similar trend for alcohol (0.65; 0.42-1.0; p = 0.0501). Compared with subjects with AD, subjects with DLB were younger (72.5 vs 74.9 years, p = 0.021) and more likely to be male (odds ratio; 95% confidence interval) (5.3; 3.3-8.5; p < 0.0001), have a history of depression (4.3; 2.4-7.5; p < 0.0001), be more educated (2.5; 1.1-5.6; p = 0.031), have a positive family history of PD (5.0; 2.4-10; p < 0.0001), have no APOE ε4 alleles (0.61; 0.40-0.93; p = 0.02), and to have had an oophorectomy before age 45 years (7.6; 1.5-39; p = 0.015).

CONCLUSION:

DLB risk factors are an amalgam of those for AD and PD. Smoking and education, which have opposing risk effects on AD and PD, are not risk factors for DLB; however, depression and low caffeine intake, both risk factors for AD and PD, increase risk of DLB more strongly than in either.