Xu Tian, Ji Yong, Wang Pan, Wu Hao, Liu Shuai, Lv Zhaoyang, Ren Xiaoqiao, Liu Jia, Wang Zihan, Lu Hao, Shi Zhihong
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, 300070, Tianjin, China.
Department of Neurology and Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin University, 300350, Tianjin, China.
Parkinsonism Relat Disord. 2025 Jul 7;138:107953. doi: 10.1016/j.parkreldis.2025.107953.
Parkinson's disease without dementia (PD-ND), Parkinson's disease with dementia (PDD), and dementia with Lewy bodies (DLB) are Lewy body disorders characterized by intraneuronal Lewy body pathology. Although the sequence of motor and cognitive symptom onset assists in differentiating PDD from DLB, overlapping clinical features often complicate diagnosis. This study compared cognitive profiles, neuropsychiatric symptoms, and magnetic resonance imaging (MRI) characteristics among PD-ND, PDD, and DLB to identify potential diagnostic markers.
A retrospective review was conducted of 213 patients with PD-ND, 85 with PDD, 140 with DLB, and 86 age-matched cognitively normal controls seen between 2011 and 2025. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Neuropsychiatric symptoms and MRI visual rating scales, including ventricular enlargement, global cortical atrophy, medial temporal atrophy, parietal atrophy (Koedam score), white matter hyperintensities, Fazekas scale, Evans Index, and width of the third ventricle, were evaluated.
PDD patients exhibited longer disease duration than those with DLB (P < 0.001). DLB cases demonstrated lower MMSE and MoCA scores and greater neuropsychiatric symptom severity (all P < 0.01). DLB showed more extensive structural brain changes compared to both PD-ND and PDD. A combined imaging model yielded an AUC of 0.768.
DLB is associated with more rapid cognitive decline, greater neuropsychiatric burden, and more pronounced atrophy compared to PDD. Combined imaging measures may improve differential diagnosis.
无痴呆帕金森病（PD-ND）、帕金森病痴呆（PDD）和路易体痴呆（DLB）是由神经元内路易体病理特征所定义的路易体疾病。尽管运动和认知症状出现的顺序有助于区分PDD和DLB，但重叠的临床特征常常使诊断复杂化。本研究比较了PD-ND、PDD和DLB患者的认知特征、神经精神症状和磁共振成像（MRI）特征，以确定潜在的诊断标志物。
对2011年至2025年间就诊的213例PD-ND患者、85例PDD患者、140例DLB患者以及86例年龄匹配的认知正常对照者进行回顾性研究。使用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知表现。评估神经精神症状和MRI视觉评分量表，包括脑室扩大、全脑皮质萎缩、内侧颞叶萎缩、顶叶萎缩（科丹评分）、白质高信号、法泽卡斯量表、埃文斯指数和第三脑室宽度。
PDD患者的病程长于DLB患者（P < 0.001）。DLB患者的MMSE和MoCA评分较低，神经精神症状严重程度更高（均P < 0.01）。与PD-ND和PDD相比，DLB患者的脑结构改变更为广泛。联合成像模型的曲线下面积（AUC）为0.768。
与PDD相比，DLB患者的认知衰退更快，神经精神负担更重，萎缩更明显。联合成像测量可能有助于改善鉴别诊断。
