Oculomotor Testing in the Differential Diagnosis of Dementia

Assistance Publique - Hôpitaux de Paris65 enrolled

Overview

The aim of this study is to determine whether saccadic eye movement recording may help in the discrimination between Lewy body dementia and Alzheimer disease, in the early stages of the disease. Study type: Interventional Study design: Intervention Model: Single group assignment Primary purpose: Diagnostic

Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia. In its early stages, the differential diagnosis of DLB and Alzheimer's disease (AD) can be challenging. The differential diagnosis is particularly important given that patients with DLB respond well to cholinesterase inhibitors but show sensitivity to neuroleptic medications which are contraindicated in DLB. DLB tends to progress more quickly than Alzheimer's disease. Diagnostic accuracy may be improved. Oculomotor recording, easy to perform could be helpful in order to identify and reliably assess fluctuating attention performance in DLB patients. Main objective: \- to improve differential diagnosis between DLB and AD in the early stages of the disease with oculomotor measurements Secondary objectives: * to examine the association between the oculomotor records and neuropsychological examination assessing attention abilities and their fluctuations * to evaluate the benefit of complementary neuropsychological tests in the distinction between DLB and AD cases * to examine the relationship between hippocampal volume and neuropsychological examination in DLB cases * to examine the diagnostic performance of MRI (Support Vector Machine) between DLB and AD * to examine the interest of CSF alpha synuclein concentration to discriminate DLB from AD * to assess at one year variations in oculomotor test scores and neuropsychological test scores Method and design Longitudinal multicenter study including 100 patients with a DLB or AD diagnosis. Clinical examination at one year.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Lewy Body Disease Alzheimer's Disease

Interventions

oculomotor measurementsOTHER

The variability is indicated by the coefficient of variation (i.e. standard-error/mean) of saccades latencies in the gap paradigm. Mean reflexive saccades latency Percentage of express saccades

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 65 and over * Patients with a diagnosis of probable DLB or AD according to the Consortium on DLB criteria (McKeith et al 2005) for Lewy bodies dementia and according to DSM IV and NINCDS- ADRDA criteria for AD or patients in whom there is diagnostic uncertainty between DLB and AD * No major sensory deficits * MMSE \> 20 * Having signed an informed consent form Exclusion Criteria: * Parkinson syndrome progressing for more than one year regarding cognitive impairment * Use of AchEIs medication * Taking or having taken anti Parkinson drugs * Neuroleptic drugs over the previous three months * Contraindication for lumbar puncture (i.e. anticoagulant agents) * Patients with Geriatric Depression Scale (GDS) \> 10 * Taking medication that could impact dopamine transporter's measurement * Contraindication for MRI examination * Diseases involving the short-term survival (shorter than one year) * Not fluent in French * Major sensory deficits that could interfere with cognitive assessment (visual and auditory) * Being under guardianship * Absence of caregiver/informant to sign informed consent form * Non health insurance affiliation

Locations (1)

Assistance Publique Hôpitaux de Paris - Pitié-Salpetriere hospital

Paris, France

Outcomes

Primary Outcomes

Variability of reflexive saccades latencies

The variability is indicated by the coefficient of variation (i.e. standard-error/mean) of saccades latencies in the gap paradigm. The variability and mean latency are expected to be increased while the percentage of express latencies decreased in DLB patients

Time frame: at one year

Secondary Outcomes

Correlations between oculomotor records and neuropsychological examination assessing attention abilities and their fluctuations

This indicator concerns the standard Bravais-Pearson correlations between saccades latencies values and scores in neuropsychological tests.

Time frame: at one year

Potential correlations between hippocampal volume and neuropsychological examination in DLB cases

This indicator concerns the standard Bravais-Pearson correlations between neuro-psychological test scores and the measures of hippocampal volume

Time frame: at one year

Cerebral atrophy differences between DLB and AD using SVM (Support Vector Machine) method

score differences between the two groups

Time frame: at one year

Percentage of alpha synuclein in CSF to discriminate DLB from AD

score differences between the two groups

Time frame: at one year

Variations at one year in oculomotor test scores and neuropsychological test scores

comparing baseline and follow-up performance separately for each group

Time frame: at one year

Mean reflexive saccades latency

Data from ClinicalTrials.gov

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