路易体变异型认知功能衰退比阿尔茨海默病更快。

Cognitive decline is faster in Lewy body variant than in Alzheimer's disease.

作者信息

Olichney J M, Galasko D, Salmon D P, Hofstetter C R, Hansen L A, Katzman R, Thal L J

机构信息

Department of Neurosciences, University of California, San Diego and San Diego Veteran's Affairs Medical Center, 92161, USA.

出版信息

Neurology. 1998 Aug;51(2):351-7. doi: 10.1212/wnl.51.2.351.

DOI:10.1212/wnl.51.2.351

PMID:9710002

Abstract

OBJECTIVES

To quantify the rate of cognitive decline on the Mini-Mental State Examination (MMSE) in autopsy-diagnosed Lewy body variant (LBV) of Alzheimer's disease (AD) cases. We hypothesized that LBV patients would have a faster cognitive decline and shorter survival compared with patients with pure AD.

BACKGROUND

Prior reports have shown extrapyramidal signs to be associated with a poorer prognosis in AD. It has been suggested that LBV is often characterized by a rapidly progressive course. Few data are available regarding the rate of cognitive decline in autopsy-confirmed LBV dementia cases.

METHODS

We searched the databases of the University of California-San Diego Alzheimer's Disease Research Center and the Consortium to Establish a Registry in Alzheimer's Disease (CERAD) for dementia cases with 1) an autopsy diagnosis of definite or probable AD (CERAD criteria) with concomitant Lewy bodies and 2) longitudinal MMSE assessments. This resulted in a series of 40 LBV cases and 148 AD cases without Lewy bodies, with comparable baseline MMSE scores, age, and education. The rate of cognitive decline was calculated as the baseline MMSE -- final MMSE. Methods were devised to reduce floor effects on the MMSE.

RESULTS

The average rate of cognitive decline was -5.8 +/- 4.5 points/y in LBV and -4.1 +/- 3.0 points/y in AD (t-test, p < 0.01). The LBV group declined a similar amount on the MMSE (means, -10.0 versus -9.6 points) over a significantly shorter time interval (1.9 versus 2.7 years; p = 0.005) than did AD patients. At baseline, the mean MMSE scores were nearly identical (18.2 in LBV; 17.8 in AD), but on follow-up examinations approximately 1, 2, and 3 years later, there were intergroup mean differences of 1.8 points (two-tailed p = 0.19), 4.2 points (p = 0.04), and 5.6 points (p = 0.03), respectively. The LBV cases had shorter survival time from the onset of cognitive symptoms (7.7 +/- 3.0 years versus 9.3 +/- 3.5 years; p = 0.007) and a shorter mean survival after entry/baseline, which was of marginal significance (3.6 versus 4.1 years; p = 0.11).

CONCLUSIONS

This study demonstrates that LBV is characterized by a faster cognitive decline and accelerated mortality compared with AD.

摘要

目的

量化经尸检确诊的阿尔茨海默病（AD）路易体变异型（LBV）患者简易精神状态检查表（MMSE）的认知衰退率。我们假设与单纯AD患者相比，LBV患者的认知衰退更快，生存期更短。

背景

既往报告显示锥体外系症状与AD患者预后较差相关。有人提出，LBV通常具有快速进展的病程特点。关于经尸检确诊的LBV痴呆病例的认知衰退率，可用数据很少。

方法

我们检索了加利福尼亚大学圣地亚哥分校阿尔茨海默病研究中心数据库以及阿尔茨海默病注册协会（CERAD）数据库，查找符合以下条件的痴呆病例：1）经尸检诊断为明确或很可能的AD（CERAD标准）且伴有路易体；2）有纵向MMSE评估。结果得到了40例LBV病例和148例无路易体的AD病例，两组患者的基线MMSE评分、年龄和受教育程度具有可比性。认知衰退率的计算方法为基线MMSE评分减去最终MMSE评分。我们设计了一些方法来减少MMSE中的地板效应。

结果

LBV患者认知衰退的平均速率为-5.8±4.5分/年，AD患者为-4.1±3.0分/年（t检验，p<0.01）。与AD患者相比，LBV组在显著更短的时间间隔内MMSE评分下降幅度相近（平均值分别为-10.0分和-9.6分）（1.9年对2.7年；p=0.005）。基线时，两组的平均MMSE评分几乎相同（LBV组为18.2分，AD组为17.8分），但在大约1年、2年和3年后的随访检查中，组间平均差异分别为1.8分（双侧p=0.19）、4.2分（p=0.04）和5.6分（p=0.03）。LBV病例从认知症状出现开始的生存期较短（7.7±3.0年对9.3±3.5年；p=0.007），进入研究/基线后的平均生存期也较短，差异接近显著水平（3.6年对4.1年；p=0.11）。