Liampas Ioannis, Siokas Vasileios, Stamati Polyxeni, Zoupa Elli, Tsouris Zisis, Provatas Antonios, Kefalopoulou Zinovia, Chroni Elisabeth, Lyketsos Constantine G, Dardiotis Efthimios
Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
Larisa Day Care Center of People with Alzheimer's Disease, Association for Regional Development and Mental Health (EPAPSY), Marousi, Greece.
J Am Geriatr Soc. 2025 Jan;73(1):50-62. doi: 10.1111/jgs.19238. Epub 2024 Nov 5.
Motor signs may herald incident dementia and allow the earlier detection of high-risk individuals and the timely implementation of preventive interventions. The current study was performed to investigate the prognostic properties of motor signs with respect to incident dementia with Lewy bodies (DLB) in older adults with mild cognitive impairment (MCI). Emphasis was placed on sex differences. The specificity of these associations was explored.
We analyzed data from the National Alzheimer's Coordinating Center Uniform Data Set. Participants 55 + years old with a diagnosis of MCI were included in the analysis. Those with Parkinson's disease (PD) or other parkinsonian disorders at baseline and those with PD dementia at follow-up were excluded. UPDRS III was used to assess the presence or absence of motor signs in nine domains: hypophonia; masked facies; resting tremor; action/postural tremor; rigidity; bradykinesia; impaired chair rise; impaired posture/gait; postural instability. Αdjusted Cox proportional hazards models featuring sex by motor sign interactions were estimated.
Throughout the average follow-up of 3.7 ± 3.1 years, among 4623 individuals with MCI, 2211 progressed to dementia (66 of whom converted to DLB). Masked facies [HR = 4.21 (1.74-10.18)], resting tremor [HR = 4.71 (1.44-15.40)], and bradykinesia [HR = 3.43 (1.82-6.45)] exclusively increased the risk of DLB. The HR of DLB was approximately 15 times greater in women compared to men with masked facies. Impaired posture-gait (approximately 10 times) and resting tremor (approximately 8.5 times) exhibited a similar trend (prominent risk-conferring properties in women compared to men) but failed to achieve statistical significance. Rigidity and hypophonia elevated the risk of other dementia entities, as well. The remaining motor features were not related to incident dementia of any type.
Specific motor signs may herald DLB among individuals with MCI. Different associations may exist between masked facies, impaired posture-gait, resting tremor, and incident DLB in men versus women.
运动症状可能预示着新发痴呆，并有助于更早发现高危个体以及及时实施预防性干预措施。本研究旨在调查轻度认知障碍（MCI）老年人群中运动症状对于路易体痴呆（DLB）新发的预后特性。重点关注性别差异。探讨了这些关联的特异性。
我们分析了来自国家阿尔茨海默病协调中心统一数据集的数据。纳入分析的参与者年龄在55岁及以上，诊断为MCI。排除基线时患有帕金森病（PD）或其他帕金森综合征以及随访时患有PD痴呆的患者。采用统一帕金森病评定量表第三部分（UPDRS III）评估九个领域中运动症状的有无：声音低微；面具脸；静止性震颤；动作性/姿势性震颤；肌强直；运动迟缓；从椅子上站起困难；姿势/步态障碍；姿势不稳。估计了以性别与运动症状交互作用为特征的调整后Cox比例风险模型。
在平均3.7±3.1年的随访期间，4623例MCI患者中，2211例进展为痴呆（其中66例转变为DLB）。仅面具脸[风险比（HR）=4.21（1.74 - 10.18）]、静止性震颤[HR = 4.71（1.44 - 15.40）]和运动迟缓[HR = 3.43（1.82 - 6.45）]增加了患DLB的风险。有面具脸的女性患DLB的HR约为男性的15倍。姿势 - 步态障碍（约10倍）和静止性震颤（约8.5倍）呈现出类似趋势（女性相比男性具有更显著的风险赋予特性），但未达到统计学显著性。肌强直和声音低微也增加了患其他痴呆类型的风险。其余运动特征与任何类型的新发痴呆均无关联。
特定运动症状可能预示MCI个体患DLB。男性与女性在面具脸、姿势 - 步态障碍、静止性震颤和新发DLB之间可能存在不同的关联。
