Breitve Monica H, Chwiszczuk Luiza J, Hynninen Minna J, Rongve Arvid, Brønnick Kolbjørn, Janvin Carmen, Aarsland Dag
Section of Mental Health Research, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Old Age Department, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway.
Section of Mental Health Research, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Neurological Department, Clinic of Medicine, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway.
Alzheimers Res Ther. 2014 Sep 16;6(5-8):53. doi: 10.1186/s13195-014-0053-6. eCollection 2014.
The aim of this review was to investigate whether there is a faster cognitive decline in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD) over time.
PsycINFO and Medline were searched from 1946 to February 2013. A quality rating from 1 to 15 (best) was applied to the included studies. A quantitative meta-analysis was done on studies with mini mental state examination (MMSE) as the outcome measure.
A total of 18 studies were included. Of these, six (36%) reported significant differences in the rate of cognitive decline. Three studies reported a faster cognitive decline on MMSE in patients with mixed DLB and AD compared to pure forms, whereas two studies reported a faster decline on delayed recall and recognition in AD and one in DLB on verbal fluency. Mean quality scores for studies that did or did not differ were not significantly different. Six studies reported MMSE scores and were included in the meta-analysis, which showed no significant difference in annual decline on MMSE between DLB (mean 3.4) and AD (mean 3.3).
Our findings do not support the hypothesis of a faster rate of cognitive decline in DLB compared to AD. Future studies should apply recent diagnostic criteria, as well as extensive diagnostic evaluation and ideally autopsy diagnosis. Studies with large enough samples, detailed cognitive tests, at least two years follow up and multivariate statistical analysis are also needed.
本综述的目的是研究路易体痴呆（DLB）患者随时间推移的认知衰退是否比阿尔茨海默病（AD）更快。
检索了1946年至2013年2月的PsycINFO和Medline数据库。对纳入研究应用了1至15分（最佳）的质量评分。对以简易精神状态检查表（MMSE）作为结果指标的研究进行了定量荟萃分析。
共纳入18项研究。其中，6项（36%）报告了认知衰退率的显著差异。3项研究报告，与单纯形式相比，混合性DLB和AD患者在MMSE上的认知衰退更快；而2项研究报告AD患者在延迟回忆和识别方面衰退更快，1项研究报告DLB患者在语言流畅性方面衰退更快。有差异和无差异的研究的平均质量得分无显著差异。6项研究报告了MMSE分数并纳入荟萃分析，结果显示DLB（平均3.4）和AD（平均3.3）在MMSE年度衰退方面无显著差异。
我们的研究结果不支持DLB患者认知衰退比AD更快的假设。未来的研究应采用最新的诊断标准，以及广泛的诊断评估，理想情况下进行尸检诊断。还需要有足够大样本量、详细认知测试、至少两年随访以及多变量统计分析的研究。
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