Gender differences in early presentation and pathological subtypes in dementia with Lewy bodies
Gender differences in early presentation and pathological subtypes in dementia with Lewy bodies
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路易体痴呆早期表现和病理亚型的性别差异
DOI：
10.1111/psyg.12626
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Iritani S.
中科院分区：
文献类型：
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作者：
Fujishiro H;Torii Y;Iritani S.
编辑先生，我们怀着极大的兴趣阅读了内海等人的文章，1标题为OCharacteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease：incidence of symptoms and gender differences。作者报告了234例患者的早期表现的性别差异，这些患者的路易体痴呆（DLB）基于生物标志物的临床诊断是由综合医院的精神科做出的。初次就诊时幻觉和抑郁的总体发生率女性（49.6%）显著高于男性（32.7%）。相比之下，快速眼动睡眠行为障碍在男性（12.9%）中的发病率明显高于女性（3.0%）。这一发现支持了孤立的快速眼动睡眠行为障碍是男性占主导地位的睡眠障碍。女性（79.2 ± 8.0岁）和男性（78.6 ± 6.7岁）之间的平均年龄没有差异。在这项研究中，133名（56.8%）参与者是女性。鉴于DLB早期表现的性别差异，所选病例的性别比例可能影响样本人群的临床特征。该综述文章报告了DLB临床样本中性别比例的不一致结果。当控制样本人群的性别时，五项研究报告了不成比例的DLB女性，三项研究报告了不成比例的DLB男性。病理学研究也报告了不一致的结果。在美国的一项大型多中心尸检系列中，3当DLB在病理学上被定义为新皮质或边缘型路易体病（LBD），神经系统缠结少于Braak III期时，尸检时DLB患者倾向于男性（男性：女性比值比= 2.91，95%置信区间：2.02-4.18）。这项研究发现，男性比女性更有可能在死亡时有新皮质路易体病理学。尸检发现，不同年龄组的男性患者几乎一致地出现新皮质路易体病理。相比之下，日本的一项基于社区的研究报告称，女性的路易体病理学倾向于扩散到整个新皮质区域：在37名患有LBD的女性中，20名（54.0%）患有新皮质型。4在22例男性LBD患者中，仅4例（18.1%）为新皮质型。这些病理学研究发生在不同的环境中，LBD亚型的比例可能高度依赖于病例选择。货车de比克等人在阿姆斯特丹痴呆队列的223例DLB患者中证明了脑脊液生物标志物与性别特异性相关：包括39名女性（平均年龄：70 ± 6岁）和184名男性（平均年龄：68 ± 7岁）。5当数据经年龄调整后，女性脑脊液中α-突触核蛋白水平和β-淀粉样蛋白1-42水平低于男性。tau蛋白和磷酸化tau蛋白浓度无性别差异。临床上，女性年龄较大，幻觉更频繁，在简易精神状态检查中得分较低。增加对临床表现中性别差异的理解可能有助于提高DLB诊断的准确性，并为临床试验研究的设计提供指导。DLB不同样本人群的性别差异有待进一步研究并经病理学证实。
Dear Editor, We read with great interest the article by Utsumi et al., 1 titled OCharacteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differencesL. The authors reported gender differences in the early presentation of 234 patients whose biomarker-based clinical diagnosis of dementia with Lewy bodies (DLB) was made by the department of psychiatry at a general hospital. The overall incidence of hallucinations and depression at initial presentation was significantly higher in women (49.6%) than in men (32.7%). In contrast, rapid eye movement sleep behaviour disorder at initial presentation was significantly more common in men (12.9%) than in women (3.0%). This finding supports that isolated rapid eye movement sleep behaviour disorder is male-predominant parasomnia. There was no difference in the mean age between women (79.2+ 8.0 years) and men (78.6+ 6.7 years). In this study, 133 (56.8%) participants were women. Given the gender differences in the early presentation of DLB, the gender ratios of the cases selected could have influenced the clinical characteristics of the sample population. The review article reported inconsistent results regarding gender ratios in clinical samples of DLB. 2 When controlling for the gender of the sample population, five studies reported disproportionately more women with DLB, and three studies reported disproportionately more men with DLB. Pathological studies have also reported inconsistent results. In a large multicentre autopsy series from the United States, 3 when DLB was pathologically defined as the neocortical or limbic type of Lewy body disease (LBD) with less neurofibrillary tangle than in Braak stage III, patients with DLB at autopsy tended to be men (male: female odds ratio= 2.91, 95% confidence interval: 2.02-4.18). This study found that men were far more likely than women to have neocortical Lewy body pathology at death. The predominance of male patients with neocortical Lewy body pathology was found at autopsy almost uniformly across different age groups. In contrast, a community-based study from Japan reported that Lewy body pathology in women tended to spread throughout the regions of the neocortex: of 37 women with LBD, 20 (54.0%) had neocortical type. 4 Of 22 men with LBD, only 4 (18.1%) had neocortical type. These pathological studies occurred in different settings, and the proportion of LBD subtypes may be highly dependent on case selection.Van de Beek et al. demonstrated gender-specific associations with profiles of cerebrospinal fluid biomarkers in 223 patients with DLB from the Amsterdam Dementia Cohort: 39 women (mean age: 70+ 6 years) and 184 men (mean age: 68+ 7 years) were included. 5 When the data were adjusted for age, women had a lower α-synuclein level and lower β-amyloid 1-42 levels in cerebrospinal fluid than men. There were no gender differences for tau and phosphorylated tau concentrations. Clinically, women were older, had more frequent hallucinations, and scored lower on the Mini-Mental State Examination. Increased understanding of gender differences in clinical presentation may help improve the accuracy of DLB diagnoses and provide guidance in the design of clinical trial studies. Further studies are needed regarding gender differences in various sample populations of DLB with pathological verification.
路易体痴呆中脑脊液生物标志物的性别特异性关联
DOI：
10.1186/s13195-020-00610-9
发表时间：
2020
期刊：
Alzheimer's Research & Therapy
影响因子：
--
作者：
M. Beek;R. B. Mofrad;I. V. Steenoven;H. Vanderstichele;Ph. Scheltens;C. Teunissen;A. Lemstra;W. V. D. Flier
通讯作者：
W. V. D. Flier