Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease
Survival and mortality differences between dementia with Lewy bodies vs Alzheimer disease
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DOI：
10.1212/01.wnl.0000247041.63081.98
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发表时间：
2006-12-12
期刊：
影响因子：
9.9
通讯作者：
Galvin, James E.
中科院分区：
文献类型：
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作者：
Williams, Monique M.;Xiong, Chengjie;Galvin, James E.
目的：探讨路易体痴呆是否比阿尔茨海默病进展更快。方法：我们比较了315名参与者(63名DLB患者和252名AD患者)，他们参加了一项关于记忆和衰老的前瞻性纵向研究，并进行了年度临床和认知评估，并进行了跟踪调查，直至死亡。主要的结果衡量标准是痴呆症进展到住院和死亡。在这项研究中，所有参与者都进行了神经病理学检查。以神经病理学为基础进行主题分类(DLBvs AD)。结果：与AD患者相比，DLB患者的死亡风险增加(危险比[HR]1.88，95%CI：1.4~2.5)。DLB组和AD组的中位生存期分别为78.0年和84.6年(X(2)=19.9，p<；0.001)，性别(HR1.5 1，95%CI：1.0~2.3)和至少1个APOE epsilon 4等位基因的存在(HR 1.5 0，95%CI：1.0~2.2)具有显著的遗传修饰效应。痴呆发作后的存活率在DLB和AD之间也有差异(7.3年vs8.5年；chi(2)=5.4，p<；0.02)。DLB病例与AD病例具有类似的在长期护理机构中住院和存活的风险。抑郁的自我报告和锥体外系体征的存在是重要的协变量。通过心理测量表现和临床分期方法测量的认知功能减退率在DLB和AD之间没有差异。结论：与阿尔茨海默病(AD)相比，路易体痴呆(DLB)增加了死亡风险，但两组在认知功能减退率上没有差异。与AD相比，DLB患者非认知性疾病进展的风险更大，这表明这两种疾病在临床上有意义的差异。
Objective: To determine whether dementia with Lewy bodies (DLB) progresses more rapidly than Alzheimer disease (AD). Methods: We compared 315 participants (63 with DLB and 252 with AD) enrolled in a prospective longitudinal study of memory and aging with annual clinical and cognitive assessments and followed until death. The main outcome measure was dementia progression to institutionalization and death. Neuropathologic examinations were performed on all participants in this study. Subject classification (DLB vs AD) was based on neuropathology. Results: Patients with DLB had an increased risk of mortality vs patients with AD (hazard ratio [HR] 1.88, 95% CI: 1.4 to 2.5). The median survival time for DLB was 78.0 years and for AD was 84.6 years (chi(2) = 19.9, p < 0.001) with significant modification effects due to gender (HR 1.51, 95% CI: 1.0 to 2.3) and the presence of at least 1 APOE epsilon 4 allele (HR 1.50, 95% CI: 1.0 to 2.2). Survival after dementia onset was also different between DLB and AD (7.3 vs 8.5 years; chi(2) = 5.4, p < 0.02). DLB cases had similar risks of institutionalization and survival in long-term care facilities to AD cases. Self-reports of depression and the presence of extrapyramidal signs were important covariates. The rate of cognitive decline as measured by psychometric performance and clinical staging methods did not differ between DLB and AD. Conclusions: Dementia with Lewy bodies (DLB) increases the risk of mortality compared with Alzheimer disease (AD), but the two groups did not differ in rate of cognitive decline. The greater risk for noncognitive disease progression for DLB compared with AD suggests clinically meaningful differences for the two disorders.