Kramberger Milica G, Auestad Bjørn, Garcia-Ptacek Sara, Abdelnour Carla, Olmo Josep Garre, Walker Zuzana, Lemstra Afina W, Londos Elisabet, Blanc Frederic, Bonanni Laura, McKeith Ian, Winblad Bengt, de Jong Frank Jan, Nobili Flavio, Stefanova Elka, Petrova Maria, Falup-Pecurariu Cristian, Rektorova Irena, Bostantjopoulou Sevasti, Biundo Roberta, Weintraub Daniel, Aarsland Dag
Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
J Alzheimers Dis. 2017;57(3):787-795. doi: 10.3233/JAD-161109.
BACKGROUND/OBJECTIVE: The aim of this study was to describe the rate and clinical predictors of cognitive decline in dementia with Lewy bodies (DLB), and compare the findings with Alzheimer's disease (AD) and Parkinson's disease dementia (PDD) patients.
Longitudinal scores for the Mini-Mental State Examination (MMSE) in 1,290 patients (835 DLB, 198 PDD, and 257 AD) were available from 18 centers with up to three years longitudinal data. Linear mixed effects analyses with appropriate covariates were used to model MMSE decline over time. Several subgroup analyses were performed, defined by anti-dementia medication use, baseline MMSE score, and DLB core features.
The mean annual decline in MMSE score was 2.1 points in DLB, compared to 1.6 in AD (p = 0.07 compared to DLB) and 1.8 in PDD (p = 0.19). Rates of decline were significantly higher in DLB compared to AD and PDD when baseline MMSE score was included as a covariate, and when only those DLB patients with an abnormal dopamine transporter SPECT scan were included. Decline was not predicted by sex, baseline MMSE score, or presence of specific DLB core features.
The average annual decline in MMSE score in DLB is approximately two points. Although in the overall analyses there were no differences in the rate of decline between the three neurodegenerative disorders, there were indications of a more rapid decline in DLB than in AD and PDD. Further studies are needed to understand the predictors and mechanisms of cognitive decline in DLB.
背景/目的：本研究旨在描述路易体痴呆（DLB）患者认知功能下降的速率及临床预测因素，并将研究结果与阿尔茨海默病（AD）和帕金森病痴呆（PDD）患者进行比较。
来自18个中心的1290例患者（835例DLB、198例PDD和257例AD）有简易精神状态检查表（MMSE）的纵向评分，纵向数据最长达三年。采用带有适当协变量的线性混合效应分析对MMSE随时间的下降情况进行建模。根据抗痴呆药物使用情况、基线MMSE评分和DLB核心特征进行了几项亚组分析。
DLB患者MMSE评分的年平均下降值为2.1分，AD患者为1.6分（与DLB相比，p = 0.07），PDD患者为1.8分（p = 0.19）。当将基线MMSE评分作为协变量纳入分析时，以及仅纳入多巴胺转运体SPECT扫描异常的DLB患者时，DLB患者的下降速率显著高于AD和PDD患者。下降情况无法通过性别、基线MMSE评分或特定DLB核心特征的存在来预测。
DLB患者MMSE评分的年平均下降值约为2分。虽然在总体分析中，这三种神经退行性疾病的下降速率没有差异，但有迹象表明DLB患者的下降速度比AD和PDD患者更快。需要进一步研究以了解DLB患者认知功能下降的预测因素和机制。
