Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Geriatric Division, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
Singapore Med J. 2020 Oct;61(10):551-558. doi: 10.11622/smedj.2019103. Epub 2019 Sep 6.
Alzheimer's disease (AD) and Lewy body dementia (LBD) are two common forms of dementia. There are still controversies regarding whether LBD patients have a worse clinical course than AD patients.
We retrospectively reviewed all biomarkers that supported AD and LBD patients presenting to the Memory Clinic of Queen Mary Hospital, Hong Kong, between 1 January 2008 and 30 December 2016. Diagnoses of AD and LBD were supported by clinical diagnostic criteria and biomarkers. LBD patients included those with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). Baseline demographics, presenting clinical features, degree of cognitive impairment and specified clinical outcomes were compared.
We recruited 31 AD and 25 LBD patients (18 DLB, 7 PDD). When measured from disease onset, LBD patients were noted to have shorter overall survival (p = 0.02) with earlier occurrence of falls (p < 0.001), dysphagia (p < 0.001), pneumonia (p = 0.01), pressure injuries (p = 0.003) and institutionalisation (p = 0.03) than AD patients. Cox regression analyses showed that LBD predicted falls (hazard ratio [HR] 5.86, 95% confidence interval [CI] 2.29-15.01, p < 0.001), dysphagia (HR 10.06, 95% CI 2.50-40.44, p = 0.001), pressure injuries (HR 17.39, 95% CI 1.51-200.10, p = 0.02), institutionalisation (HR 2.72, 95% CI 1.12-6.60, p = 0.03) and death (HR 2.96, 95% CI 1.18-7.42, p = 0.02).
LBD patients had shorter overall survival with earlier occurrence of pre-specified long-term events compared with AD patients. LBD also independently predicted pre-specified long-term events.
阿尔茨海默病（AD）和路易体痴呆（LBD）是两种常见的痴呆症。关于 LBD 患者的临床病程是否比 AD 患者更差，仍存在争议。
我们回顾性分析了 2008 年 1 月 1 日至 2016 年 12 月 30 日期间在香港玛丽医院记忆诊所就诊的所有支持 AD 和 LBD 患者的生物标志物。AD 和 LBD 的诊断均支持临床诊断标准和生物标志物。LBD 患者包括痴呆伴路易体（DLB）和帕金森病痴呆（PDD）患者。比较了基线人口统计学、临床表现、认知障碍程度和特定临床结局。
我们招募了 31 名 AD 和 25 名 LBD 患者（18 名 DLB，7 名 PDD）。从疾病发病开始测量时，LBD 患者的总生存期更短（p = 0.02），更早发生跌倒（p < 0.001）、吞咽困难（p < 0.001）、肺炎（p = 0.01）、压疮（p = 0.003）和住院（p = 0.03）。Cox 回归分析显示，LBD 预测跌倒（风险比 [HR] 5.86，95%置信区间 [CI] 2.29-15.01，p < 0.001）、吞咽困难（HR 10.06，95% CI 2.50-40.44，p = 0.001）、压疮（HR 17.39，95% CI 1.51-200.10，p = 0.02）、住院（HR 2.72，95% CI 1.12-6.60，p = 0.03）和死亡（HR 2.96，95% CI 1.18-7.42，p = 0.02）。
与 AD 患者相比，LBD 患者的总生存期更短，更早发生预先指定的长期事件。LBD 还独立预测了预先指定的长期事件。
