Case 2 (autopsy case) At age 73 this lady was admitted to Camarillo State Hospital with history of progressive mental disorder for the preceeding 8 months. She developed the delusion that strange men were entering her room and doing something to her causing physical harm. The delusion as supported by visual and somatic delusions. Her complaints also suggested olfactory hallucinations. She had special locks installed on her doors. As the symptoms progressed she complained that the men were walking through the walls. The examination at admission revealed the patient to be fearfull and agitated. Memory impairment was not noted but she was described as “totally lacking in judgement and insight”. After a psychological assessment she received a diagnosis of chronic paranoid schizophrenia in spite of her advanced age. No neurological ampairment was elicited. During her hospitalization of 4 years a partial remission in her mental symptoms was acheived with medication. These symptoms exacerbated during the four months preceeding death. The cause of death was bronchopneumonia. The neuropathologic study revealed “classical” Lewy bodies in the brain stem nuclei.
The Camarillo 1200 series included 45 similar cases in whch classical Lewy bodies were encountered as an isolated entity and without clear-cut clinical or pathologic features of dementia ( Woodard, 2007). That series included 135 cases of mental illness admitted at age 55 or older without clear-cut clinical dementia or pathologic criteria of dementia. In this subgroup 28% had classical brain stem Lewy bodies compared to 1% in the control material. This leaves no doubt that the association between classical Lewy bodies and mental illness is real and very significant. Most of these patients had incapacitating mental symptoms for many years prior to the Camarillo State Hospital admission but they presented a wide range of clinical diagnoses. Confusion in the literature results from inapropriately attributing dementia to “diffuse Lewy bodies” and from the inadequate pathologic criteria for the diagnosis of Alzheimer’s disease.
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Tags: Alzheimer's disease, Lewy body
