Prodromal Dementia with Lewy Bodies and Prodromal Alzheimer's Disease: A Comparison of the Cognitive and Clinical Profiles
Prodromal Dementia with Lewy Bodies and Prodromal Alzheimer's Disease: A Comparison of the Cognitive and Clinical Profiles
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DOI：
10.3233/jad-161089
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发表时间：
2017-01-01
影响因子：
4
通讯作者：
Walker, Zuzana
中科院分区：
文献类型：
--
作者：
Sadiq, Dilman;Whitfield, Tim;Walker, Zuzana
背景：痴呆症必须在病程早期准确诊断，才能使病理特异性治疗有效。路易体痴呆 (DLB) 经常被误诊为阿尔茨海默病 (AD)，尤其是在前驱阶段。目的：比较轻度认知障碍 (MCI) 患者的临床和神经心理学特征，这些患者在随访时进展为 AD（回顾性 AD-MCI）或 DLB（回顾性 DLB-MCI）或仍为 MCI。方法：这项纵向研究使用了未选择的样本记忆诊所数据库。 1994 年至 2015 年间，记忆诊所共接诊了 1,848 名新患者。其中，560 名患者 (30%) 初步诊断为 MCI，并考虑参加该研究。纳入标准是在初次评估时诊断为 MCI 并至少进行 12 个月随访的患者。 结果：在 429 名有随访数据的 MCI 患者中，164 名 (38%) 仍为 MCI，107 名 (25%) 进展为 AD，21 名 (5%) 进展为 DLB。其余的则进展为替代诊断。基线时，DLB-MCI 患者在视觉空间功能和字母流利度测试中的表现显着低于 AD-MCI 和稳定 MCI 组，而在情景记忆测试中则优于 AD-MCI 组。在基线时，DLB-MCI 患者的平均 UPDRS 评分显着较高，并且更有可能患有 REM 睡眠行为障碍和认知波动。 结论：DLB-MCI 患者具有特定的认知和神经精神特征，应提醒临床医生前驱 DLB 的可能性。当在早期疾病特异性治疗的背景下考虑时，这是相关的。
Background: Dementia must be diagnosed accurately and early in the disease course to allow pathology-specific treatments to be effective. Dementia with Lewy bodies (DLB) is often misdiagnosed as Alzheimer's disease (AD), especially at the prodromal stage.Objective: To compare the clinical and neuropsychological profiles of Mild Cognitive Impairment (MCI) patients who, at follow-up, progressed to AD (retrospectively AD-MCI) or DLB (retrospectively DLB-MCI) or remained MCI.Methods: This longitudinal study used an unselected sample from a memory clinic database. A total of 1,848 new patients were seen at the memory clinic between 1994-2015. Of these, 560 patients (30%) had an initial diagnosis of MCI and were considered for the study. Inclusion criteria were patients who had a diagnosis of MCI at initial assessment and a minimum of 12 months' follow-up.Results: Of the 429 MCI patients with follow-up data, 164 (38%) remained MCI, 107 (25%) progressed to AD, and 21 (5%) progressed to DLB. The remainder progressed to alternative diagnoses. At baseline, DLB-MCI patients performed significantly worse on visuospatial function and letter fluency tests than both AD-MCI and stable-MCI groups, and better on episodic memory tests than the AD-MCI group. At baseline, DLB-MCI patients had a significantly higher mean UPDRS score and were more likely to have REM sleep behavior disorder and fluctuating cognition.Conclusion: DLB-MCI patients have a specific cognitive and neuropsychiatric profile which should alert clinicians to the possibility of prodromal DLB. This is relevant when considered in the context of early disease-specific therapy.