Blanc Frédéric, Bouteloup Vincent, Paquet Claire, Chupin Marie, Pasquier Florence, Gabelle Audrey, Ceccaldi Mathieu, de Sousa Paulo Loureiro, Krolak-Salmon Pierre, David Renaud, Fischer Clara, Dartigues Jean-François, Wallon David, Moreaud Olivier, Sauvée Mathilde, Belin Catherine, Roubaud Claire, Botzung Anne, Ravier Alix, Demuynck Catherine, Namer Izzie, Habert Marie-Odile, Bousiges Olivier, Schorr Benoît, Muller Candice, Philippi Nathalie, Chêne Geneviève, Cretin Benjamin, Mangin Jean-François, Dufouil Carole
CM2R (Memory Resource and Research Centre), Service of Gerontology Mobile-Neuro-Psy-Research, Geriatrics Department, University Hospital of Strasbourg, 21, Rue David Richard, Strasbourg, 67000, France.
CNRS, ICube laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS, University of Strasbourg, Strasbourg, France.
Geroscience. 2025 May 25. doi: 10.1007/s11357-025-01701-x.
The cognitive and neuroimaging evolution over the course of dementia with Lewy bodies (DLB) from prodromal stage - Pro-DLB (subjective (SCI) to mild cognitive impairment (MCI)) - is poorly understood. The aim of this study was to analyze from 5-year longitudinal data the trajectories of Pro-DLB patients. The "Lewy- MEMENTO" prospective clinical cohort recruited 773 patients for either SCI or MCI. The Pro-DLB group was compared to a group with prodromal Alzheimer's disease (Pro-AD), a group with "prodromal DLB and AD" (Pro-DLB + AD), and a group without prodromal DLB and AD (no symptom [NS]). We modeled the 5-year evolution of cognitive functions and the 2-year evolution of brain MRI volumetry on MRI and brain metabolism (FDG PET). The Pro-AD and Pro-DLB + AD groups had more cognitive and functional decline than the Pro-DLB and NS groups (P < .001). The Pro-DLB group had more cognitive decline than the NS group (P < .004). Incident dementia during the follow-up was higher in the Pro-AD (13.0 per 100 person-years) and Pro-DLB + AD (10.3) groups than in the Pro-DLB (1.02) and NS (0.44) groups (P < .001). The decline in the metabolism of the left orbitofrontal cortex was greater in the Pro-DLB + AD group. The volume decrease of hippocampi, entorhinal cortices, amygdalae, and left insula was higher in the Pro-AD and the pro-DLB + AD groups. Patients in the pro-DLB group had less cognitive, functional, brain volume, and metabolism decrease than patients in the Pro-AD and pro-DLB + AD groups. DLB would therefore be a less degenerative and more dysfunctional disease at the prodromal stage.
路易体痴呆（DLB）从前驱期 - 前驱性DLB（主观认知障碍（SCI）至轻度认知障碍（MCI））过程中的认知和神经影像学演变情况尚不清楚。本研究的目的是通过5年纵向数据来分析前驱性DLB患者的病程轨迹。“路易体 - MEMENTO”前瞻性临床队列招募了773例SCI或MCI患者。将前驱性DLB组与前驱性阿尔茨海默病（Pro-AD）组、“前驱性DLB和AD”（Pro-DLB + AD）组以及无前驱性DLB和AD（无症状[NS]）组进行比较。我们对认知功能的5年演变以及MRI和脑代谢（FDG PET）上脑MRI体积测量的2年演变进行了建模。Pro-AD组和Pro-DLB + AD组的认知和功能衰退比前驱性DLB组和NS组更严重（P <.001）。前驱性DLB组的认知衰退比NS组更严重（P <.004）。随访期间，Pro-AD组（每100人年13.0例）和Pro-DLB + AD组（10.3例）的新发痴呆高于前驱性DLB组（1.02例）和NS组（0.44例）（P <.001）。Pro-DLB + AD组左侧眶额皮质的代谢下降更大。Pro-AD组和Pro-DLB + AD组海马体、内嗅皮质、杏仁核和左侧岛叶的体积减小更明显。前驱性DLB组患者的认知、功能、脑体积和代谢下降程度低于Pro-AD组和Pro-DLB + AD组患者。因此，DLB在前驱期可能是一种退化程度较低但功能障碍更明显的疾病。
