PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center; Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan.
Psychogeriatrics. 2013 Jun;13(2):128-38. doi: 10.1111/psyg.12005.
Dementia with Lewy bodies (DLB) is defined pathologically as neurodegeneration associated with Lewy bodies (LB). LB-related symptoms, including olfactory dysfunction, dysautonomia, and mood and sleep disorders, are increasingly recognized as clinical signs that enable the early detection of DLB, because these symptoms often antedate dementia by years or even decades. It remains unknown if the clinical history of LB-related symptoms is sufficient for the prodromal state of DLB to be suspected in memory clinics. We retrospectively investigated the clinical courses, including olfactory dysfunction, dysautonomia, depression, and rapid eye movement sleep behaviour disorder, of 90 patients with probable DLB. The timing of LB-related symptoms that preceded or followed relative to the onset of memory loss was calculated. LB-related symptoms were present in 79 of 90 patients (87.8%) with probable DLB before or at the time of memory loss onset. These symptoms preceded the onset of memory loss between 1.2 and 9.3 years. We also report on four non-demented patients with a clinical history of LB-related symptoms in our memory clinic. All four patients showed reduced cardiac [(123) I]-metaiodobenzylguanidine levels. Moreover, [(18) F]fluoro-D-glucose positron emission tomography scans revealed glucose hypometabolism in the occipital cortex in two patients. One patient converted to probable DLB with the development of parkinsonism 2 years after major depression was diagnosed. Based on a clinical history of LB-related symptoms, we propose a conceptual framework to identify these symptomatic but non-demented individuals that led us to suspect the underlying pathophysiology of Lewy body disease. Further prospective study is warranted to determine the clinical significance of LB-related symptoms in non-demented patients.
路易体痴呆（DLB）在病理学上定义为与路易体（LB）相关的神经退行性变。LB 相关症状，包括嗅觉功能障碍、自主神经功能障碍、情绪和睡眠障碍，越来越被认为是能够早期发现 DLB 的临床体征，因为这些症状通常在痴呆症出现多年甚至几十年前就出现了。目前尚不清楚在记忆诊所中，LB 相关症状的临床病史是否足以怀疑 DLB 的前驱状态。我们回顾性调查了 90 例可能的 DLB 患者的临床病程，包括嗅觉功能障碍、自主神经功能障碍、抑郁和快速眼动睡眠行为障碍。计算了 LB 相关症状在记忆丧失之前或之后相对于记忆丧失发作的时间。在 90 例可能的 DLB 患者中，79 例（87.8%）在记忆丧失发作之前或同时出现了 LB 相关症状。这些症状在记忆丧失发作前出现的时间为 1.2 至 9.3 年。我们还报告了在我们的记忆诊所中，有 4 例非痴呆患者有 LB 相关症状的临床病史。这 4 例患者均表现出心脏 [(123) I]-间碘苄胍摄取减少。此外，[(18) F]氟-D-葡萄糖正电子发射断层扫描显示，两名患者的枕叶皮质葡萄糖代谢减少。一名患者在被诊断为重度抑郁症后 2 年发展为帕金森病，转化为可能的 DLB。基于 LB 相关症状的临床病史，我们提出了一个概念框架来识别这些有症状但无痴呆的个体，这使我们怀疑路易体疾病的潜在病理生理学。需要进一步的前瞻性研究来确定非痴呆患者 LB 相关症状的临床意义。
