Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Mov Disord. 2020 May;35(5):859-867. doi: 10.1002/mds.27997. Epub 2020 Feb 11.
The objective of this study was to examine clinical characteristics, cognitive decline, and predictors for time to dementia in prodromal dementia with Lewy bodies with mild cognitive impairment (MCI-LB) compared with prodromal Alzheimer's disease (MCI-AD).
We included 73 MCI-LB patients (12% female; 68 ± 6 years; Mini Mental State Examination, 27 ± 2) and 124 MCI-AD patients (48% female; 68 ± 7 years; Mini Mental State Examination, 27 ± 2) from the Amsterdam Dementia Cohort. Follow-up was available for 61 MCI-LB patients and all MCI-AD patients (3 ± 2 years). We evaluated dementia with Lewy bodies core features, neuropsychiatric symptoms, caregiver burden (Zarit caregiver burden interview), MRI, apolipoprotein genotype, and cerebrospinal fluid biomarkers (tau/Aβ ratio). Longitudinal outcome measures included cognitive slopes (memory, attention, executive functions, and language and visuospatial functions) and time to dementia.
Parkinsonism was the most frequently present core feature in MCI-LB (69%). MCI-LB patients more often had neuropsychiatric symptoms and scored higher on ZARIT when compared with the MCI-AD patients. Linear mixed models showed that at baseline, MCI-LB patients performed worse on nonmemory cognitive domains, whereas memory performance was worse in MCI-AD patients. Over time, MCI-LB patients declined faster on attention, whereas MCI-AD patients declined faster on the Mini Mental State Examination and memory. Cox proportional hazards regressions showed that in the MCI-LB patients, lower attention (hazard ratio [HR] = 1.6; 95% confidence interval [CI], 1.1-2.3) and more posterior cortical atrophy (HR = 3.0; 95% CI, 1.5-5.8) predicted shorter time to dementia. In the MCI-AD patients, worse performance on memory (HR = 1.1; 95% CI, 1.0-1.2) and executive functions (HR = 1.3; 95% CI, 1.0-1.6) were independently associated with time to Alzheimer's dementia.
MCI-LB patients have distinct neuropsychiatric and cognitive profiles with prominent decline in attention when compared with MCI-AD patients. Our results highlight the importance of early diagnosis because symptoms already have an impact in the prodromal stages. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
本研究旨在比较前驱期路易体痴呆伴轻度认知障碍（MCI-LB）与前驱期阿尔茨海默病（MCI-AD）患者的临床特征、认知下降及痴呆发生时间的预测因素。
我们纳入了 73 例 MCI-LB 患者（12%为女性；68±6 岁；简易精神状态检查量表，27±2）和 124 例 MCI-AD 患者（48%为女性；68±7 岁；简易精神状态检查量表，27±2），均来自阿姆斯特丹痴呆队列。61 例 MCI-LB 患者和所有 MCI-AD 患者（3±2 年）可获得随访。我们评估了路易体痴呆的核心特征、神经精神症状、照料者负担（Zarit 照料者负担访谈）、MRI、载脂蛋白基因型和脑脊液生物标志物（tau/Aβ 比值）。纵向结局指标包括认知斜率（记忆、注意力、执行功能以及语言和视空间功能）和痴呆发生时间。
帕金森病是 MCI-LB 中最常见的核心特征（69%）。与 MCI-AD 患者相比，MCI-LB 患者更常出现神经精神症状，Zarit 评分更高。线性混合模型显示，基线时，MCI-LB 患者在非记忆认知领域的表现更差，而 MCI-AD 患者的记忆表现更差。随着时间的推移，MCI-LB 患者的注意力下降速度更快，而 MCI-AD 患者的 Mini Mental State Examination 和记忆下降速度更快。Cox 比例风险回归显示，在 MCI-LB 患者中，注意力较差（风险比[HR] = 1.6；95%置信区间[CI]，1.1-2.3）和更严重的皮质后部萎缩（HR = 3.0；95%CI，1.5-5.8）预测痴呆发生时间更短。在 MCI-AD 患者中，记忆（HR = 1.1；95%CI，1.0-1.2）和执行功能（HR = 1.3；95%CI，1.0-1.6）的表现更差与发生阿尔茨海默病痴呆的时间独立相关。
与 MCI-AD 患者相比，MCI-LB 患者具有明显不同的神经精神和认知特征，注意力下降更为突出。我们的研究结果强调了早期诊断的重要性，因为症状在前驱期已经产生影响。© 2020 作者。运动障碍协会由 Wiley 期刊出版公司代表国际帕金森病和运动障碍协会出版。
