Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
J Parkinsons Dis. 2018;8(4):553-561. doi: 10.3233/JPD-181367.
Whether dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are distinct disorders or two subtypes of the same entity, is not yet fully understood. There is a dearth of knowledge on differences in longitudinal clinical outcomes between DLB and PDD.
We aimed to compare longitudinal trend of cognitive decline, mortality, and their determinant factors between patients with DLB and PDD.
At baseline, we recruited 1110 DLB, and 764 PDD patients registered in the Swedish dementia registry (SveDem) during 2007-2015. Cognitive status was assessed at baseline and each follow-up visit by mini-mental state examination (MMSE). At least one follow-up MMSE was available for 411 (37.0%) DLB and 229 (30.0%) PDD patients. Rate of cognitive decline and mortality risk were compared between the two groups.
After an average of 2-years, the rate of cognitive decline did not differ between DLB (1.1 MMSE unit/year) and PDD (1.2 MMSE unit/year) groups (p = 0.970). There was no significant difference in the median survival time between DLB (4.0 years) and PDD (4.1 years) groups (Log rank p = 0.614). Antipsychotic drug use in DLB and larger number of medications in PDD were the most important determinants of faster annual cognitive decline.
Our findings from real-world clinical practice demonstrated that the rate of cognitive decline and mortality do not differ significantly between DLB and PDD at least over 2 years, yet, various factors might determine clinical outcome in these two groups. It seems that DLB and PDD are probably similar synucleinopathies, with phenotypical variations in the order of manifestations rather than course of progression and clinical outcome.
路易体痴呆（DLB）和帕金森病痴呆（PDD）是否为两种不同的疾病，还是同一实体的两种亚型，目前尚未完全明确。对于 DLB 和 PDD 之间纵向临床结局的差异，我们知之甚少。
我们旨在比较 DLB 和 PDD 患者认知能力下降、死亡率及其决定因素的纵向变化趋势。
在基线时，我们招募了 1110 例 2007 年至 2015 年期间在瑞典痴呆登记处（SveDem）登记的 DLB 患者和 764 例 PDD 患者。使用简易精神状态检查（MMSE）评估基线和每次随访时的认知状态。至少有一次随访 MMSE 的患者中，DLB 患者为 411 例（37.0%），PDD 患者为 229 例（30.0%）。比较两组之间认知能力下降和死亡率风险。
平均随访 2 年后，DLB 组（每年 1.1 个 MMSE 单位）和 PDD 组（每年 1.2 个 MMSE 单位）的认知能力下降速度无差异（p = 0.970）。DLB 组（4.0 年）和 PDD 组（4.1 年）的中位生存时间无显著差异（对数秩检验 p = 0.614）。DLB 中使用抗精神病药物和 PDD 中使用更多药物是导致每年认知能力下降更快的最重要决定因素。
我们从真实临床实践中得出的发现表明，至少在 2 年内，DLB 和 PDD 之间的认知能力下降速度和死亡率无显著差异，但两组的各种因素可能决定临床结局。DLB 和 PDD 可能属于类似的突触核蛋白病，其表现形式的表型差异大于进展和临床结局的差异。
