Department of Psychiatry, Osaka University Graduate School of Medicine, D3 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Alzheimers Res Ther. 2022 Sep 22;14(1):137. doi: 10.1186/s13195-022-01080-x.
This study aimed to identify cases of potential prodromal DLB in very late-onset schizophrenia-like psychosis (VLOSLP), using indicative biomarkers of dementia with Lewy bodies (DLB), and to evaluate the characteristics of psychosis as prodromal DLB.
Data of patients with VLOSLP without dementia and Parkinsonism, who underwent testing for at least one indicative biomarker of DLB, were retrospectively collected from the database of the psychiatry clinic at the Osaka University Hospital. Patients were divided into two groups based on the positive (VLOSLP+LB) and negative (VLOSLP-LB) results of the indicative biomarkers of DLB. Age, gender, cognitive battery scores, prevalence of each type of delusions and hallucinations, cerebral volume, and cerebral perfusion were compared between the two groups.
Eleven VLOSLP+LB and 23 VLOSLP-LB participants were enrolled. There were no significant differences in age, proportion of females, and MMSE scores between the two groups. The standardized score of the digit symbol substitution test was significantly lower in the VLOSLP+LB than in VLOSLP-LB group (6.9 [3.1] vs. 10.0 [2.7], p = 0.005). The prevalence of visual hallucinations was significantly higher in the VLOSLP+LB group than in the VLOSLP-LB group (81.8% vs. 26.1%, p = 0.003). Auditory hallucinations were prevalent in both groups (43.5% in VLOSLP-LB, and 45.5% in VLOSLP+LB). Among patients with auditory hallucinations, auditory hallucinations without coexistent visual hallucinations tended to be more prevalent in VLOSLP-LB (7 out of 10) than in VLOSLP+LB patients (1 out of 5). Although cerebral volume was not different in any region, cerebral perfusion in the posterior region, including the occipital lobe, was significantly lower in the VLOSLP+LB group.
Psychomotor slowing, visual hallucinations, and reduced perfusion in the occipital lobe may be suggestive of prodromal DLB in VLOSLP patients, even though the clinical manifestations were similar in many respects between VLOSLP+LB and VLOSLP-LB. Although auditory hallucinations were prevalent in both groups, most patients in VLOSLP+LB complained of auditory hallucinations along with visual hallucinations. Future studies with a larger number of patients without selection bias are desirable.
本研究旨在通过指示性路易体痴呆（DLB）生物标志物，识别极晚发性精神分裂症样精神病（VLOSLP）中潜在的前驱 DLB 病例，并评估精神病作为前驱 DLB 的特征。
从大阪大学医院精神病学诊所的数据库中回顾性收集了无痴呆和帕金森病的 VLOSLP 患者的数据，这些患者至少接受了一项 DLB 指示性生物标志物检测。根据 DLB 指示性生物标志物的阳性（VLOSLP+LB）和阴性（VLOSLP-LB）结果，将患者分为两组。比较两组的年龄、性别、认知成套测验评分、各种妄想和幻觉的患病率、脑容量和脑灌注。
共纳入 11 名 VLOSLP+LB 和 23 名 VLOSLP-LB 参与者。两组间年龄、女性比例和 MMSE 评分无显著差异。VLOSLP+LB 组数字符号替代测验的标准化评分明显低于 VLOSLP-LB 组（6.9[3.1] vs. 10.0[2.7]，p=0.005）。VLOSLP+LB 组视觉幻觉的患病率明显高于 VLOSLP-LB 组（81.8% vs. 26.1%，p=0.003）。两组均有听觉幻觉（VLOSLP-LB 组 43.5%，VLOSLP+LB 组 45.5%）。听觉幻觉伴发视觉幻觉者中，VLOSLP-LB 组（7 例）多于 VLOSLP+LB 组（5 例）。尽管各脑区脑容量无差异，但 VLOSLP+LB 组后颅区（包括枕叶）脑灌注明显降低。
运动迟缓、视觉幻觉和枕叶灌注减少可能提示 VLOSLP 患者存在前驱 DLB，尽管 VLOSLP+LB 和 VLOSLP-LB 患者在许多方面临床表现相似。尽管两组均有听觉幻觉，但 VLOSLP+LB 组多数患者伴有视觉幻觉。未来需要进行更大规模、无选择偏倚的研究。
