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June 25, 1997

Predicting Progression of Alzheimer Disease-Reply

Author Affiliations

Sergievsky Center New York, NY

JAMA. 1997;277(24):1934. doi:10.1001/jama.1997.03540480034031

In Reply.  —The issue of whether some of our cases suffered from dementia with Lewy bodies (DLB), as opposed to Alzheimer disease (AD), is indeed important. Extrapyramidal signs and psychotic features have been noted in both AD without Lewy bodies and DLB.1,2 In recruiting our cohort, we carefully applied clinical diagnostic criteria in an attempt to include only cases of probable AD3 and differentiate them from DLB.4 Thus, the onset of cognitive changes in our group was more typical of probable AD than DLB, none of our patients had fluctuating cognition, and only 2 had persistent visual hallucinations. Our autopsy data on 44 patients suggest that we were quite successful in excluding DLB: only 1 patient met pathologic criteria for DLB alone and another for senile changes of the AD type with concomitant DLB. In contrast, 37 met criteria for AD with neuritic plaques and neocortical tangles.While we