Oh Daniel M, Jiao Jocelyn M, Wang Xinhui, Ahuja Ashim, Caceres Nenette A, Clark Kristi A, Chui Helena, Ringman John M
Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA.
Department of Neurology, Kaiser Permanente, Riverside, California, USA.
Mov Disord Clin Pract. 2025 Jun;12(6):754-763. doi: 10.1002/mdc3.14341. Epub 2025 Jan 23.
The neuropathologies of Alzheimer's disease (AD) and Lewy body disease (LBD) commonly co-occur. Parkinsonism is the hallmark feature in LBD but it can be difficult to predict the presence of these co-pathologies early in the course of clinical disease. Timely diagnosis has crucial implications, especially with the advent of disease-modifying therapies.
We sought to define early motor features that predict the ultimate neuropathological diagnoses of normal, AD, AD with concurrent LB pathology, and pure LB.
We examined the associations between individuals' early motor features from their initial visit using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III and their neuropathological diagnoses using the U.S. National Alzheimer's Coordinating Center (NACC) Database.
We included data from participants with neuropathologically normal brains (n = 49), AD (n = 502), AD w/LB (n = 167), and pure LB (n = 51). Total UPDRS Part III scores were increasingly higher with purer LB pathology. Decreased facial expression at baseline differentiated those with AD w/LB pathology from those with AD. Participants having pure LB pathology more often had deficits in speech, facial expression, posture, gait, bradykinesia, and upper extremity rigidity relative to those with AD w/LB.
Diminished facial expression significantly predicted the presence of LBs among those with concurrent AD pathology. Worse early speech, facial expression, posture, gait, bradykinesia, and upper extremity rigidity were suggestive of more pure LB pathology. These findings emphasize the utility of the neurological exam in the clinical assessment of persons with cognitive complaints as it can guide management.
阿尔茨海默病（AD）和路易体病（LBD）的神经病理学特征常常同时出现。帕金森症是LBD的标志性特征，但在临床疾病过程早期很难预测这些合并病理学特征的存在。及时诊断具有至关重要的意义，尤其是随着疾病修饰疗法的出现。
我们试图确定能够预测正常、AD、合并路易小体（LB）病理学特征的AD以及单纯LB最终神经病理学诊断结果的早期运动特征。
我们使用统一帕金森病评定量表（UPDRS）第三部分，研究了个体初诊时的早期运动特征与其使用美国国家阿尔茨海默病协调中心（NACC）数据库得出的神经病理学诊断结果之间的关联。
我们纳入了神经病理学检查大脑正常的参与者（n = 49）、AD患者（n = 502）、合并LB的AD患者（n = 167）以及单纯LB患者（n = 51）的数据。UPDRS第三部分的总分随着LB病理学特征越纯粹而越高。基线时面部表情减少可将合并LB病理学特征的AD患者与AD患者区分开来。相对于合并LB的AD患者，单纯LB病理学特征的参与者在言语、面部表情、姿势步态、运动迟缓及上肢僵硬方面的缺陷更为常见。
面部表情减弱显著预示了合并AD病理学特征患者中存在LB。早期言语、面部表情、姿势步态、运动迟缓及上肢僵硬情况较差提示存在更纯粹的LB病理学特征。这些发现强调了神经学检查在有认知主诉者临床评估中的作用，因为它可以指导治疗管理。
