Kemp Jennifer, Philippi Nathalie, Phillipps Clélie, Demuynck Catherine, Albasser Timothée, Martin-Hunyadi Catherine, Schmidt-Mutter Catherine, Cretin Benjamin, Blanc Frédéric
Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.
Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.
Alzheimers Res Ther. 2017 Mar 16;9(1):19. doi: 10.1186/s13195-017-0242-1.
Cortical and subcortical cognitive impairments have been found in dementia with Lewy bodies (DLB). Roughly, they comprise visuoconstructive and executive dysfunction, whereas memory would remain relatively spared. However, the cognitive profile of patients with prodromal DLB remains poorly illustrated to date.
We included 37 patients with prodromal DLB (age 67.2 ± 8.6 years, 18 men, Mini Mental State Examination [MMSE] score 27.4 ± 2) and 29 healthy control subjects (HCs; age 68.8 ± 7.9 years, 15 men, MMSE score 29.0 ± 0.9). They were presented with an extensive neuropsychological test battery to assess memory; speed of processing; executive function; visuoperceptual, visuospatial and visuoconstructive abilities; language; and social cognition.
Compared with HCs, patients had lower scores on a visual recognition memory test (Delayed Matching to Sample-48 items; p ≤ 0.021) and lower free recall (all p ≤ 0.035), but not total recall, performance on a verbal episodic memory test (Free and Cued Selective Reminding Test). Short-term memory (p = 0.042) and working memory (p = 0.002) scores were also lower in patients. Assessment of executive function showed no slowing but overall lower performance in patients than in HCs (all p ≤ 0.049), whereas assessment of instrumental function yielded mixed results. Indeed, patients had lower scores on language tests (p ≤ 0.022), apraxia for pantomime of tool use (p = 0.002) and imitation of meaningless gesture (p = 0.005), as well as weakened visuospatial abilities (p = 0.047). Visuoconstruction was also impaired in patients. However, visuoperceptual abilities did not differ between groups. Finally, theory of mind abilities were lower in patients than in HCs (p < 0.05), but their emotion recognition abilities were similar.
This study presents the cognitive profile in patients with prodromal DLB. In line with the literature on DLB with dementia, our results show lower performance on tests of executive function and visuoconstruction. However, we found, from a prodromal stage of DLB, memory (free recall and visual recognition) and social cognition deficits, as well as weakened visuospatial and praxic abilities.
在路易体痴呆（DLB）中已发现皮质和皮质下认知障碍。大致上，它们包括视觉构建和执行功能障碍，而记忆相对保留。然而，前驱期DLB患者的认知概况迄今仍未得到充分说明。
我们纳入了37例前驱期DLB患者（年龄67.2±8.6岁，男性18例，简易精神状态检查表[MMSE]评分27.4±2）和29名健康对照者（HCs；年龄68.8±7.9岁，男性15例，MMSE评分29.0±0.9）。他们接受了一系列广泛的神经心理学测试，以评估记忆、处理速度、执行功能、视觉感知、视觉空间和视觉构建能力、语言及社会认知。
与HCs相比，患者在视觉识别记忆测试（延迟样本匹配-48项；p≤0.021）中的得分较低，在言语情景记忆测试（自由和线索选择性提醒测试）中的自由回忆得分较低（所有p≤0.035），但总回忆得分无差异。患者的短期记忆（p=0.042）和工作记忆（p=0.002）得分也较低。执行功能评估显示患者没有速度减慢，但总体表现低于HCs（所有p≤0.049），而工具功能评估结果不一。事实上，患者在语言测试（p≤0.022）、工具使用哑剧失用症（p=0.002）和无意义手势模仿（p=0.005）中的得分较低，视觉空间能力也减弱（p=0.047）。患者的视觉构建能力也受损。然而，两组之间的视觉感知能力没有差异。最后，患者的心理理论能力低于HCs（p<0.05），但他们的情绪识别能力相似。
本研究展示了前驱期DLB患者的认知概况。与关于痴呆性DLB的文献一致，我们的结果显示患者在执行功能和视觉构建测试中的表现较低。然而，我们发现，从前驱期DLB开始，患者就存在记忆（自由回忆和视觉识别）和社会认知缺陷，以及视觉空间和运用能力减弱。
