Cognitive decline is faster in Lewy body variant than in Alzheimer's disease
Cognitive decline is faster in Lewy body variant than in Alzheimer's disease
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DOI：
10.1212/wnl.51.2.351
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发表时间：
1998-08-01
期刊：
影响因子：
9.9
通讯作者：
Thal, LJ
中科院分区：
文献类型：
--
作者：
Olichney, JM;Galasko, D;Thal, LJ
目的：目的：通过简易精神状态检查量表（MMSE）对尸检确诊的路易体变异型（LBV）阿尔茨海默病（AD）患者认知功能下降的发生率进行量化。我们假设与单纯AD患者相比，LBV患者的认知功能下降更快，生存期更短。背景：先前的报道显示锥体外系体征与AD预后不良相关。有人认为，LBV的特点往往是一个快速渐进的过程。关于尸检证实的LBV痴呆病例的认知能力下降率的数据很少。研究方法：我们在加州大学圣地亚哥分校阿尔茨海默病研究中心和阿尔茨海默病登记研究联盟（CERAD）的数据库中搜索了痴呆病例，其中包括1）尸检诊断为明确或可能的AD（CERAD标准）并伴有路易体和2）纵向简易智能状态量表评估。这导致了一系列的40例LBV病例和148例AD病例没有路易体，具有可比的基线MMSE评分，年龄和教育。认知功能下降率计算为基线MMSE -最终MMSE。设计方法以减少MMSE的下限效应。结果：LBV患者认知功能下降的平均速率为-5.8 +/- 4.5分/年，AD患者为-4.1 +/- 3.0分/年（t检验，p < 0.01）。LBV组在MMSE上的下降量（平均值，-10.0对-9.6分）比AD患者在明显更短的时间间隔内（1.9对2.7年; p = 0.005）相似。基线时，平均MMSE评分几乎相同（LBV为18.2分; AD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（双尾p = 0.19）、4.2分（p = 0.04）和5.6分（p = 0.03）。LBV病例从认知症状开始的生存时间较短（7.7 +/- 3.0年vs 9.3 +/- 3.5年; p = 0.007），入组/基线后的平均生存期较短，具有边际显著性（3.6 vs 4.1年，p = 0.11）。结论：这项研究表明，LBV的特点是更快的认知能力下降和加速死亡率相比，AD。
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.