INTRODUCTION: Compared to Alzheimer's disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care. Yet, few investigations have been performed on comorbidities and risk factors of DLB. Therefore, we aimed to compare clinical risk factors and comorbidity profile in DLB and AD patients using two nationwide registries. METHODS: This is a linkage study between the Swedish dementia registry (SveDem) and the Swedish National Patient Registry conducted on 634 subjects with DLB and 9161 individuals with AD registered during the years 2007-2012. Comorbidity profile has been coded according to the International Classification of Diseases version 10 (ICD 10) in addition to the date of each event. The main chapters of the ICD-10, the Charlson score of comorbidities and a selected number of neuropsychiatric diseases were compared between the DLB and AD groups. Comorbidity was registered before and after the dementia diagnosis. RESULTS: "Mental and behavioral disorders", "diseases of the nervous system", "diseases of the eye and adnexa", diseases of the "circulatory", "respiratory", and "genitourinary" systems, "diseases of the skin and subcutaneous tissue" and "diseases of the musculoskeletal system and connective tissue" occurred more frequently in the DLB group after multivariate adjustment. Depression [adjusted OR = 2.12 (95%CI 1.49 to 3.03)] and migraine [adjusted OR = 3.65 (95%CI 1.48 to 9.0)] were more commonly recorded before the diagnosis of dementia in the DLB group. Following dementia diagnosis, ischemic stroke [adjusted OR = 1.89 (95%CI 1.21 to 2.96)] was more likely to happen among the DLB patients compared to the AD population. CONCLUSIONS: Our study indicated a worse comorbidity profile in DLB patients with higher occurrence of depression, stroke and migraine compared with the AD group. Deeper knowledge about the underlying mechanisms of these associations is needed to explore possible reasons for the different pattern of comorbidity profile in DLB compared to AD and their prognostic significance.

Division of Clinical Geriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institutet Stockholm Sweden

Division of Clinical Geriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institutet Stockholm Sweden ; Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden

Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institutet Stockholm Sweden ; Centre for Age Related Diseases Stavanger University Hospital Stavanger Norway

Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institutet Stockholm Sweden ; Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden

Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institutet Stockholm Sweden ; International Clinical Research Center and St Anne's University Hospital Brno Czech Republic

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Kalra S, Bergeron C, Lang AE. Lewy body disease and dementia. A review. Arch Intern Med. 1996;156:487–493. doi: 10.1001/archinte.1996.00440050031004. PubMed DOI

Vossius C, Testad I, Skjaeveland R, Nesvag S. The use and costs of health and social services in patients with longstanding substance abuse. BMC Health Serv Res. 2013;13:185. doi: 10.1186/1472-6963-13-185. PubMed DOI PMC

Oesterhus R, Soennesyn H, Rongve A, Ballard C, Aarsland D, Vossius C. Long-term mortality in a cohort of home-dwelling elderly with mild Alzheimer’s disease and Lewy body dementia. Dement Geriatr Cogn Disord. 2014;38:161–169. doi: 10.1159/000358051. PubMed DOI

Rongve A, Vossius C, Nore S, Testad I, Aarsland D. Time until nursing home admission in people with mild dementia: comparison of dementia with Lewy bodies and Alzheimer’s dementia. Int J Geriatr Psychiatry. 2014;29:392–398. doi: 10.1002/gps.4015. PubMed DOI

Gill DP, Hubbard RA, Koepsell TD, Borrie MJ, Petrella RJ, Knopman DS, Kukull WA. Differences in rate of functional decline across three dementia types. Alzheimers Dement. 2013;9:S63–S71. doi: 10.1016/j.jalz.2012.10.010. PubMed DOI PMC

Espallargues M, Philp I, Seymour DG, Campbell SE, Primrose W, Arino S, Dunstan E, Lamura G, Lawson P, Mestheneos E, Politynska B, Raiha I. Measuring case-mix and outcome for older people in acute hospital care across Europe: the development and potential of the ACMEplus instrument. QJM. 2008;101:99–109. doi: 10.1093/qjmed/hcm136. PubMed DOI

Garcia-Ptacek S, Farahmand B, Kareholt I, Religa D, Cuadrado ML, Eriksdotter M. Mortality risk after dementia diagnosis by dementia type and underlying factors: a cohort of 15,209 patients based on the Swedish dementia registry. J Alzheimers Dis. 2014;41:467–477. PubMed

Ballard C, Holmes C, McKeith I, Neill D, O’Brien J, Cairns N, Lantos P, Perry E, Ince P, Perry R. Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer’s disease. Am J Psychiatry. 1999;156:1039–1045. PubMed

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. Risk factors for dementia with Lewy bodies: a case–control study. Neurology. 2013;81:833–840. doi: 10.1212/WNL.0b013e3182a2cbd1. PubMed DOI PMC

Sadak TI, Katon J, Beck C, Cochrane BB, Borson S. Key neuropsychiatric symptoms in common dementias: prevalence and implications for caregivers, clinicians, and health systems. Res Gerontol Nurs. 2014;7:44–52. doi: 10.3928/19404921-20130918-01. PubMed DOI PMC

Fritze F, Ehrt U, Hortobagyi T, Ballard C, Aarsland D. Depressive symptoms in Alzheimer’s disease and lewy body dementia: a one-year follow-up study. Dement Geriatr Cogn Disord. 2011;32:143–149. doi: 10.1159/000332016. PubMed DOI

www.svedem.se Swedish Dementia Registry []

Religa D, Spangberg K, Wimo A, Edlund AK, Winblad B, Eriksdotter-Jonhagen M. Dementia diagnosis differs in men and women and depends on age and dementia severity: data from SveDem, the Swedish Dementia Quality Registry. Dement Geriatr Cogn Disord. 2012;33:90–95. doi: 10.1159/000337038. PubMed DOI

Skoldunger A, Wimo A, Johnell K. Net costs of dementia in Sweden – an incidence based 10 year simulation study. Int J Geriatr Psychiatry. 2012;27:1112–1117. doi: 10.1002/gps.2828. PubMed DOI

The ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research. World Health Organization, Geneva; 1993.

McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, Cummings J, Duda JE, Lippa C, Perry EK, Aarsland D, Arai H, Ballard CG, Boeve B, Burn DJ, Costa D, Del Ser T, Dubois B, Galasko D, Gauthier S, Goetz CG, Gomez-Tortosa E, Halliday G, Hansen LA, Hardy J, Iwatsubo T, Kalaria RN, Kaufer D, Kenny RA, Korczyn A. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65:1863–1872. doi: 10.1212/01.wnl.0000187889.17253.b1. PubMed DOI

Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6. PubMed DOI

Razavi D, Ljung R, Lu Y, Andren-Sandberg A, Lindblad M. Reliability of acute pancreatitis diagnosis coding in a National Patient Register: a validation study in Sweden. Pancreatology. 2011;11:525–532. doi: 10.1159/000331773. PubMed DOI

Armitage JN, van der Meulen JH. Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score. Br J Surg. 2010;97:772–781. doi: 10.1002/bjs.6930. PubMed DOI

Gordon M, Stark A, Skoldenberg OG, Karrholm J, Garellick G. The influence of comorbidity scores on re-operations following primary total hip replacement: comparison and validation of three comorbidity measures. Bone Joint J. 2013;95-B:1184–1191. doi: 10.1302/0301-620X.95B9.31006. PubMed DOI

Fereshtehnejad SM, Religa D, Westman E, Aarsland D, Lokk J, Eriksdotter M. Demography, diagnostics, and medication in dementia with Lewy bodies and Parkinson’s disease with dementia: data from the Swedish Dementia Quality Registry (SveDem) Neuropsychiatr Dis Treat. 2013;9:927–935. doi: 10.2147/NDT.S45840. PubMed DOI PMC

McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet. 2000;356:2031–2036. doi: 10.1016/S0140-6736(00)03399-7. PubMed DOI

Wang HF, Yu JT, Tang SW, Jiang T, Tan CC, Meng XF, Wang C, Tan MS, Tan L. Efficacy and safety of cholinesterase inhibitors and memantine in cognitive impairment in Parkinson’s disease, Parkinson’s disease dementia, and dementia with Lewy bodies: systematic review with meta-analysis and trial sequential analysis. J Neurol Neurosurg Psychiatry. 2014;ᅟ:ᅟ. [Epub ahead of print] PubMed

Aarsland D, Ballard C, Walker Z, Bostrom F, Alves G, Kossakowski K, Leroi I, Pozo-Rodriguez F, Minthon L, Londos E. Memantine in patients with Parkinson’s disease dementia or dementia with Lewy bodies: a double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2009;8:613–618. doi: 10.1016/S1474-4422(09)70146-2. PubMed DOI

Andreasen P, Lonnroos E, von Euler-Chelpin MC. Prevalence of depression among older adults with dementia living in low- and middle-income countries: a cross-sectional study. Eur J Pub Health. 2014;24:40–44. doi: 10.1093/eurpub/ckt014. PubMed DOI

Iranzo A, Gelpi E, Tolosa E, Molinuevo JL, Serradell M, Gaig C, Santamaria J. Neuropathology of prodromal Lewy body disease. Mov Disord. 2014;29:410–415. doi: 10.1002/mds.25825. PubMed DOI

Chuang CS, Lin CL, Lin MC, Sung FC, Kao CH. Migraine and risk of dementia: a nationwide retrospective cohort study. Neuroepidemiology. 2013;41:139–145. doi: 10.1159/000353559. PubMed DOI

Gudmundsson LS, Scher AI, Sigurdsson S, Geerlings MI, Vidal JS, Eiriksdottir G, Garcia MI, Harris TB, Kjartansson O, Aspelund T, van Buchem MA, Gudnason V, Launer LJ. Migraine, depression, and brain volume: the AGES-Reykjavik Study. Neurology. 2013;80:2138–2144. doi: 10.1212/WNL.0b013e318295d69e. PubMed DOI PMC

Hagen K, Stordal E, Linde M, Steiner TJ, Zwart JA, Stovner LJ. Headache as a risk factor for dementia: a prospective population-based study. Cephalalgia. 2014;34:327–335. doi: 10.1177/0333102413513181. PubMed DOI

Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain. 1998;121:1819–1840. doi: 10.1093/brain/121.10.1819. PubMed DOI

Demarquay G, Ryvlin P, Royet JP. Olfaction and neurological diseases: a review of the literature. Rev Neurol. 2007;163:155–167. doi: 10.1016/S0035-3787(07)90387-2. PubMed DOI

Ballard C, O’Sullivan MJ. Alzheimer disease and stroke: cognitive and neuroimaging predictors of AD and stroke. Nat Rev Neurol. 2013;9:605–606. doi: 10.1038/nrneurol.2013.215. PubMed DOI

Jellinger KA. Prevalence of vascular lesions in dementia with Lewy bodies. A postmortem study. J Neural Transm. 2003;110:771–778. doi: 10.1007/s00702-003-0822-z. PubMed DOI

Isojima D, Togo T, Kosaka K, Fujishiro H, Akatsu H, Katsuse O, Iritani S, Matsumoto T, Hirayasu Y. Vascular complications in dementia with Lewy bodies: a postmortem study. Neuropathology. 2006;26:293–297. doi: 10.1111/j.1440-1789.2006.00699.x. PubMed DOI

Mendel T, Bertrand E, Szpak GM, Stepien T, Wierzba-Bobrowicz T. Complications of severe cerebral amyloid angiopathy in the course of dementia with Lewy bodies. A case report. Folia Neuropathol. 2010;48:293–299. PubMed

Wu E, Lipton RB, Dickson DW. Amyloid angiopathy in diffuse Lewy body disease. Neurology. 1992;42:2131–2135. doi: 10.1212/WNL.42.11.2131. PubMed DOI

Dugger BN, Adler CH, Shill HA, Caviness J, Jacobson S, Driver-Dunckley E, Beach TG. Concomitant pathologies among a spectrum of parkinsonian disorders. Parkinsonism Relat Disord. 2014;20:525–529. doi: 10.1016/j.parkreldis.2014.02.012. PubMed DOI PMC

Herrmann N, Mamdani M, Lanctot KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psychiatry. 2004;161:1113–1115. doi: 10.1176/appi.ajp.161.6.1113. PubMed DOI

Jaussent I, Ancelin ML, Berr C, Peres K, Scali J, Besset A, Ritchie K, Dauvilliers Y. Hypnotics and mortality in an elderly general population: a 12-year prospective study. BMC Med. 2013;11:212. doi: 10.1186/1741-7015-11-212. PubMed DOI PMC

Langballe EM, Engdahl B, Nordeng H, Ballard C, Aarsland D, Selbaek G. Short- and long-term mortality risk associated with the use of antipsychotics among 26,940 dementia outpatients: a population-based study. Am J Geriatr Psychiatry. 2014;22:321–331. doi: 10.1016/j.jagp.2013.06.007. PubMed DOI

Rochon PA, Normand SL, Gomes T, Gill SS, Anderson GM, Melo M, Sykora K, Lipscombe L, Bell CM, Gurwitz JH. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med. 2008;168:1090–1096. doi: 10.1001/archinte.168.10.1090. PubMed DOI

Douglas IJ, Smeeth L. Exposure to antipsychotics and risk of stroke: self controlled case series study. BMJ. 2008;337:a1227. doi: 10.1136/bmj.a1227. PubMed DOI PMC

Johnell K, Religa D, Eriksdotter M. Differences in drug therapy between dementia disorders in the Swedish dementia registry: a nationwide study of over 7,000 patients. Dement Geriatr Cogn Disord. 2013;35:239–248. doi: 10.1159/000348408. PubMed DOI

Fereshtehnejad SM, Johnell K, Eriksdotter M. Anti-dementia drugs and co-medication among patients with Alzheimer’s disease: investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem) Drugs Aging. 2014;31:215–224. doi: 10.1007/s40266-014-0154-8. PubMed DOI

Gustafsson M, Karlsson S, Gustafson Y, Lovheim H. Psychotropic drug use among people with dementia–a six-month follow-up study. BMC Pharmacol Toxicol. 2013;14:56. doi: 10.1186/2050-6511-14-56. PubMed DOI PMC

Johnell K, Fastbom J. Comparison of prescription drug use between community-dwelling and institutionalized elderly in Sweden. Drugs Aging. 2012;29:751–758. doi: 10.1007/s40266-012-0002-7. PubMed DOI

Cermakova P, Fereshtehnejad SM, Johnell K, Winblad B, Eriksdotter M, Religa D. Cardiovascular medication burden in dementia disorders: a nationwide study of 19,743 dementia patients in the Swedish Dementia Registry. Alzheimers Res Ther. 2014;6:34. doi: 10.1186/alzrt264. PubMed DOI PMC

Cermakova P, Eriksdotter M, Lund LH, Winblad B, Religa P, Religa D. Heart failure and Alzheimer’s disease. J Intern Med. 2014;ᅟ:ᅟ. [Epub ahead of print] PubMed PMC

Magaki S, Yong WH, Khanlou N, Tung S, Vinters HV. Comorbidity in dementia: update of an ongoing autopsy study. J Am Geriatr Soc. 2014;62(9):1722–1728. doi: 10.1111/jgs.12977. PubMed DOI PMC

Imfeld P, Brauchli Pernus YB, Jick SS, Meier CR. Epidemiology, co-morbidities, and medication use of patients with Alzheimer’s disease or vascular dementia in the UK. J Alzheimers Dis. 2013;35:565–573. PubMed

Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer’s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology. 2002;58:62–70. doi: 10.1212/WNL.58.1.62. PubMed DOI

Eaker ED, Mickel SF, Chyou PH, Mueller-Rizner NJ, Slusser JP. Alzheimer’s disease or other dementia and medical care utilization. Ann Epidemiol. 2002;12:39–45. doi: 10.1016/S1047-2797(01)00244-7. PubMed DOI

Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi: 10.1186/1471-2458-11-450. PubMed DOI PMC

http://www.ucr.uu.se/svedem/index.php/om-svedem/arsrapporter Årsrapport SveDem 2012 []

Stroke as a Cause of Death in Death Certificates of Patients with Dementia: A Cohort Study from the Swedish Dementia Registry