Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.
Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
Ann Neurol. 2018 May;83(5):1016-1026. doi: 10.1002/ana.25239. Epub 2018 May 16.
We describe the progression of cognitive decline and identify the predictive values of cognitive tests in three groups of REM sleep behavior disorder (RBD) patients classified at their last follow-up as having Parkinson's disease (PD), dementia with Lewy bodies (DLB), or still-idiopathic.
Patients (n = 109) underwent polysomnographic, neurological, and neuropsychological assessments. We used linear mixed-model analyses to compare the progression of cognitive test performance between the three groups over a 3-year prodromal period, and performed linear regressions for a 6-year prodromal period. We compared the proportions of patients with clinically impaired performance (z scores < -1.5). DLB patients were pair-matched according to age, sex, and education to healthy controls (2:1 ratio), and receiver operating characteristic curves were performed to identify the psychometric properties of cognitive tests to predict dementia.
At follow-up, 38 patients (35%) developed a neurodegenerative disorder: 20 had PD and 18 DLB. Cognitive performance changes over time were strongly associated with later development of dementia. Clear deficits in attention and executive functions were observed 6 years before diagnosis. Verbal episodic learning and memory deficits started later, deviating from normal approximately 5 to 6 years and becoming clinically impaired at 1 to 2 years before diagnosis. Visuospatial abilities progressed variably, with inconsistent prodromal latencies. The Trail Making Test (part B), Verbal Fluency (semantic), and Rey Auditory-Verbal Learning Test (total, immediate, and delayed recalls) were the best predictors for dementia (area under the curve = 0.90-0.97).
Prodromal DLB is detectible up to 6 years before onset. For clinical utility, the Trail Making Test (part B) best detects early prodromal dementia stages, whereas Verbal Fluency (semantic) and verbal episodic learning tests are best for monitoring changes over time. Ann Neurol 2018;83:1016-1026.
我们描述了认知衰退的进展，并确定了 REM 睡眠行为障碍（RBD）患者在最后一次随访时分为帕金森病（PD）、路易体痴呆（DLB）或仍为特发性的三组患者的认知测试的预测值。
患者（n=109）接受了多导睡眠图、神经学和神经心理学评估。我们使用线性混合模型分析比较了三组患者在 3 年前驱期内认知测试表现的进展，并对 6 年前驱期进行了线性回归。我们比较了临床受损表现（z 分数<−1.5）的患者比例。DLB 患者根据年龄、性别和教育与健康对照组（2：1 比例）配对匹配，并进行了接受者操作特征曲线分析，以确定认知测试预测痴呆的心理测量特性。
随访时，38 例患者（35%）发展为神经退行性疾病：20 例为 PD，18 例为 DLB。认知功能随时间的变化与以后发生痴呆密切相关。在诊断前 6 年就观察到注意力和执行功能明显缺陷。言语情景记忆缺陷出现较晚，大约在 5 至 6 年前偏离正常，在诊断前 1 至 2 年前出现临床受损。视空间能力进展不同，前驱潜伏期不一致。连线测试（B 部分）、词语流畅性（语义）和 Rey 听觉语言学习测试（总、即刻和延迟回忆）是痴呆的最佳预测指标（曲线下面积=0.90-0.97）。
前驱性 DLB 在发病前可检测到 6 年。为了临床应用，连线测试（B 部分）最能检测早期前驱痴呆阶段，而词语流畅性（语义）和言语情景记忆测试最适合监测随时间的变化。Ann Neurol 2018;83:1016-1026.
