Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Int J Geriatr Psychiatry. 2022 Apr;37(4). doi: 10.1002/gps.5703.
Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI-LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI-AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI-LB from MCI-AD.
Ninety-three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31-item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI-AD or MCI-LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub-scales were assessed, controlling for age.
Age-adjusted severity of overall autonomic symptomatology was greater in MCI-LB (Ratio = 2.01, 95% CI: 1.37-2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI-AD did not have significantly higher autonomic symptom severity than controls overall. A cut-off of 4/5 on the COMPASS was sensitive to MCI-LB (92%) but not specific to this (42% specificity vs. MCI-AD and 52% vs. healthy controls).
Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI-AD, but such autonomic symptoms are not a specific finding. The COMPASS-31 may therefore have value as a sensitive screening test for early-stage Lewy body disease.
自主症状是突触核蛋白病的常见特征，可能是前驱路易体病的特征性表现。我们旨在评估路易体痴呆（DLB）的认知前驱期，轻度认知障碍伴路易体（MCI-LB），与认知健康的老年人相比，是否会有更严重的自主症状报告，同时也包括阿尔茨海默病（AD）引起的 MCI（MCI-AD）进行比较。我们还旨在评估自主症状量表在区分 MCI-LB 与 MCI-AD 中的效用。
93 名 MCI 患者和 33 名健康对照者接受了 31 项综合自主症状评分量表（COMPASS）评估。轻度认知障碍患者还根据当前共识标准进行了详细的临床评估和 MCI-AD 或 MCI-LB 的差异分类。在调整年龄后，评估了 COMPASS 总分和个体症状亚量表的差异。
MCI-LB 的自主症状总严重程度较高（比值=2.01，95%CI：1.37-2.96），直立不耐受和尿症状严重程度高于对照组，且胃肠道和分泌运动症状风险较高。MCI-AD 与对照组相比，自主症状严重程度总体上无显著差异。COMPASS 的 4/5 切点对 MCI-LB 敏感（92%），但特异性不高（特异性为 42%，与 MCI-AD 相比；52%，与健康对照组相比）。
路易体轻度认知障碍的自主症状严重程度高于正常衰老和 MCI-AD，但这些自主症状并不是特异性发现。因此，COMPASS-31 可能作为路易体病早期的敏感筛查测试具有一定价值。
