Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
BMJ Open. 2017 Nov 3;7(11):e017504. doi: 10.1136/bmjopen-2017-017504.
To use routine clinical data to investigate survival in dementia with Lewy bodies (DLB) compared with Alzheimer's dementia (AD). DLB is the second most common dementia subtype after AD, accounting for around 7% of dementia diagnoses in secondary care, though studies suggest that it is underdiagnosed by up to 50%. Most previous studies of DLB have been based on select research cohorts, so little is known about the outcome of the disease in routine healthcare settings.
Cambridgeshire & Peterborough NHS Foundation Trust, a mental health trust providing secondary mental health care in England.
251 DLB and 222 AD identified from an anonymised database derived from electronic clinical case records across an 8-year period (2005-2012), with mortality data updated to May 2015.
Raw (uncorrected) median survival was 3.72 years for DLB (95% CI 3.33 to 4.14) and 6.95 years for AD (95% CI 5.78 to 8.12). Controlling for age at diagnosis, comorbidity and antipsychotic prescribing the model predicted median survival for DLB was 3.3 years (95% CI 2.88 to 3.83) for males and 4.0 years (95% CI 3.55 to 5.00) for females, while median survival for AD was 6.7 years (95% CI 5.27 to 8.51) for males and 7.0 years (95% CI 5.92 to 8.73) for females.
Survival from first presentation with cognitive impairment was markedly shorter in DLB compared with AD, independent of age, sex, physical comorbidity or antipsychotic prescribing. This finding, in one of the largest clinical cohorts of DLB cases assembled to date, adds to existing evidence for poorer survival for DLB versus AD. There is an urgent need for further research to understand possible mechanisms accounting for this finding.
利用常规临床数据比较路易体痴呆（DLB）与阿尔茨海默病（AD）患者的生存情况。DLB 是继 AD 之后的第二大常见痴呆症类型，占二级保健中痴呆症诊断的约 7%，但研究表明，它的漏诊率高达 50%。之前大多数关于 DLB 的研究都是基于特定的研究队列，因此对于该疾病在常规医疗保健环境中的结果知之甚少。
剑桥和彼得伯勒国民保健信托基金会，一家在英格兰提供二级精神保健的心理健康信托机构。
从 2005 年至 2012 年的 8 年间，从电子临床病历的匿名数据库中确定了 251 例 DLB 和 222 例 AD 患者，死亡率数据更新至 2015 年 5 月。
DLB 的未校正中位生存期为 3.72 年（95%CI 3.33-4.14），AD 为 6.95 年（95%CI 5.78-8.12）。在控制诊断时的年龄、合并症和抗精神病药物的使用后，该模型预测男性 DLB 的中位生存期为 3.3 年（95%CI 2.88-3.83），女性为 4.0 年（95%CI 3.55-5.00），而 AD 的中位生存期为 6.7 年（95%CI 5.27-8.51）男性和 7.0 年（95%CI 5.92-8.73）女性。
与 AD 相比，从首次出现认知障碍到发病的生存时间在 DLB 中明显缩短，这与年龄、性别、身体合并症或抗精神病药物的使用无关。这一发现来自迄今为止最大的 DLB 临床队列之一，进一步证明了 DLB 的生存情况比 AD 差。迫切需要进一步的研究来了解导致这一发现的可能机制。
