Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, USA.
Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
Alzheimers Dement. 2023 Oct;19(10):4377-4387. doi: 10.1002/alz.13357. Epub 2023 Jul 8.
We examined the progression of extrapyramidal symptoms and signs in autopsy-confirmed dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Alzheimer's disease dementia (AD).
Longitudinal data were obtained from Arizona Study of Aging and Neurodegenerative Disease, with PDD (n = 98), AD (n = 47) and DLB (n = 48) further sub-grouped as with or without parkinsonism (DLB+ and DLB-). Within-group Unified Parkinson's Disease Rating Scale (UPDRS) -II and UPDRS-III trajectories were analyzed using non-linear mixed effects models.
In DLB, 65.6% had parkinsonism. Baseline UPDRS-II and III scores (off-stage) were highest (P < 0.001) for PDD (mean ± SD 14.3 ± 7.8 and 27.4 ± 16.3), followed by DLB+ (6.0 ± 8.8 and 17.2 ± 17.1), DLB- (1.1 ± 1.3 and 3.3 ± 5.5) and AD (3.2 ± 6.1 and 8.2 ± 13.6). Compared to PDD, the DLB+ group had faster UPDRS-III progression over 8-years (Cohen's-d range 0.98 to 2.79, P < 0.001), driven by gait (P < 0.001) and limb bradykinesia (P = 0.02) subscales.
Motor deficits progress faster in DLB+ than PDD, providing insights about expected changes in motor function.
Dementia with Lewy bodies has faster motor progression than Parkinson's disease dementia Linear and non-linear mixed modeling analysis of longitudinal data was utilized Findings have implications for clinical prognostication and trial design.
我们研究了尸检确诊的路易体痴呆（DLB）、帕金森病痴呆（PDD）和阿尔茨海默病痴呆（AD）患者的锥体外系症状和体征的进展情况。
我们从亚利桑那州衰老与神经退行性疾病研究中获得了纵向数据，其中 PDD（n=98）、AD（n=47）和 DLB（n=48）进一步分为有或无帕金森病（DLB+和 DLB-）。使用非线性混合效应模型分析组内统一帕金森病评定量表（UPDRS）-II 和 UPDRS-III 轨迹。
在 DLB 中，65.6%的患者有帕金森病。PDD 的基线 UPDRS-II 和 UPDRS-III 评分（未用药阶段）最高（P<0.001）（平均值±标准差分别为 14.3±7.8 和 27.4±16.3），其次是 DLB+（6.0±8.8 和 17.2±17.1）、DLB-（1.1±1.3 和 3.3±5.5）和 AD（3.2±6.1 和 8.2±13.6）。与 PDD 相比，DLB+组在 8 年内 UPDRS-III 的进展速度更快（Cohen's-d 范围为 0.98 至 2.79，P<0.001），这主要由步态（P<0.001）和肢体运动迟缓（P=0.02）亚量表驱动。
与 PDD 相比，DLB+患者的运动缺陷进展更快，这为我们了解运动功能的预期变化提供了线索。
路易体痴呆的运动进展比帕金森病痴呆更快 线性和非线性混合建模分析纵向数据 研究结果对临床预后和试验设计具有启示意义。
