Hamilton Calum Alexander, Donaghy Paul C, Taylor John-Paul, Ciafone Joanna, Durcan Rory, Firbank Michael, Greenfinch Gemma, Allan Louise, O'Brien John, Thomas Alan
Translational and Clinical Research Institute, https://ror.org/01kj2bm70Newcastle University, Newcastle upon Tyne, UK.
Institute of Nuclear Medicine, University College London Hospitals, London, UK.
Psychol Med. 2025 Jun 24;55:e175. doi: 10.1017/S0033291725100895.
Mild cognitive impairment with Lewy bodies (MCI-LB) may be identified prospectively based on the presence of cognitive impairment and several core clinical features (visual hallucinations, cognitive fluctuations, parkinsonism, and REM sleep behavior disorder). MCI-LB may vary in its presenting features, which may reflect differences in underlying pathological pattern, severity, or comorbidity.We aimed to assess how clinical features of MCI-LB accumulate over time, and whether this is associated with the rate of cognitive decline.
In this cohort study, 74 individuals seen with MCI-LB prospectively underwent repeated annual cognitive and clinical assessment up to nine years. Relationships between clinical features (number of core features present and specific features present) and cognitive change on the Addenbrooke's Cognitive Examination-Revised (ACE-R) were examined with time-varying mixed models. The accumulation of core clinical features over time was examined with a multi-state Markov model.
When an individual with MCI-LB endorsed more clinical features, they typically experienced a faster cognitive decline (ACE-R Score Difference β = -1.1 [-1.7 to -0.5]), specifically when experiencing visual hallucinations (β = -2.1 [-3.5 to -0.8]) or cognitive fluctuations (β = -3.4 [-4.8 to -2.1]).Individuals with MCI-LB typically acquired more clinical features with the passage of time (25.5% [20.0-32.0%] one-year probability), limiting the prognostic utility of baseline-only features.
The clinical presentation of MCI-LB may evolve over time. The accumulation of more clinical features of Lewy body disease, in particular visual hallucinations and cognitive fluctuations, may be associated with a worse prognosis in clinical settings.
路易体轻度认知障碍（MCI-LB）可根据认知障碍的存在以及若干核心临床特征（视幻觉、认知波动、帕金森症和快速眼动睡眠行为障碍）进行前瞻性识别。MCI-LB的表现特征可能有所不同，这可能反映了潜在病理模式、严重程度或合并症的差异。我们旨在评估MCI-LB的临床特征如何随时间累积，以及这是否与认知衰退率相关。
在这项队列研究中，74例MCI-LB患者前瞻性地接受了长达九年的每年重复认知和临床评估。使用时变混合模型检查临床特征（存在的核心特征数量和特定特征）与修订版Addenbrooke认知检查（ACE-R）上的认知变化之间的关系。使用多状态马尔可夫模型检查核心临床特征随时间的累积情况。
当MCI-LB患者认可更多临床特征时，他们通常经历更快的认知衰退（ACE-R评分差异β = -1.1 [-1.7至-0.5]），特别是在出现视幻觉（β = -2.1 [-3.5至-0.8]）或认知波动（β = -3.4 [-4.8至-2.1]）时。随着时间的推移，MCI-LB患者通常会出现更多临床特征（一年概率为25.5% [20.0 - 32.0%]），这限制了仅基于基线特征的预后效用。
MCI-LB的临床表现可能随时间演变。路易体病更多临床特征的累积，特别是视幻觉和认知波动，可能与临床环境中更差的预后相关。
