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Roberta Frigerio, MD; Hiroshige Fujishiro, PhD, MD; Demetrius M. Maraganore, MD; Kevin J. Klos, MD; Anthony DelleDonne, PhD; Michael G. Heckman, MS; Julia E. Crook, PhD; Keith A. Josephs, MST, MD; Joseph E. Parisi, MD; Bradley F. Boeve, MD; Dennis W. Dickson, MD; J. Eric Ahlskog, PhD, MD

Arch Neurol. 2009;66(9):1114-1119.

Objective  To explore whether associations of potential risk factors for incidental Lewy body disease (iLBD) are similar to those for Parkinson disease (PD).

Design  Brain autopsy study (1988-2004) of subjects without evidence of neurodegenerative disease or tremor who were evaluated by at least 1 physician within 1 year of death. Researchers analyzed incidental Lewy pathology blinded to clinical abstraction.

Setting  Olmsted County, Minnesota.

Subjects  Residents of Olmsted County and the immediate vicinity aged older than 60 years.

Main Outcome Measures  Whether risk factors previously associated with PD in Olmsted County are also associated with iLBD.

Results  Of 235 subjects, 34 had iLBD (14.5%). The overall risk factor profiles for iLBD and PD were fairly similar between the 2 sets of odds ratio (OR) estimates, with 11 of 16 ORs in the same direction. Prior Olmsted County studies documented 7 risk factors with statistically significant associations with PD; for physician occupation and caffeine intake, the ORs for iLBD were in the same direction and statistically significant, whereas for education, head injury, and number of children, they were in the same direction but not significant; they were in the opposite direction but not statistically significant for depression and anxiety. Incidental Lewy body disease was not associated with various end-of-life conditions or causes of death, though these patients were slightly older and more likely cachectic.

Conclusions  Based on this exploratory study, iLBD and PD appear to have similar risk factor profiles. Thus, at least some cases of iLBD could represent preclinical PD, arrested PD, or a partial syndrome due to a lesser burden of causative factors. Incidental Lewy body disease is not explained by nonspecific end-of-life brain insults.

Author Affiliations: Departments of Neurology (Drs Frigerio, Maraganore, Josephs, Boeve, and Ahlskog) and Laboratory Medicine and Pathology (Dr Parisi), Mayo Clinic, Rochester, Minnesota; Department of Neuroscience and Neuropathology (Drs Fujishiro, DelleDonne, and Dickson), and Biostatistics Unit (Mr Heckman and Dr Crook), Mayo Clinic, Jacksonville, Florida; and the Movement Disorder Clinic of Oklahoma, Tulsa (Dr Klos).

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