Mild cognitive impairment with Lewy bodies: Clinical characteristics and risk factors for progression: Neuropsychiatry and behavioral neurology: DLB and FTD — clinical manifestations. (7th December 2020)

• Record Type: Journal Article
• Authors: van de Beek, Marleen; van Steenoven, Inger; van der Zande, Jessica J.; Barkhof, Frederik; Teunissen, Charlotte E.; van Der Flier, Wiesje; Lemstra, Evelien
• Is Part Of: Alzheimer's & dementia. Volume 16(2020)Supplement 6
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-12-07
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.039094
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Little is known about the clinical presentation and prognosis of patients with mild cognitive impairment with Lewy Bodies (MCI‐LB). We aimed to describe clinical characteristics, cognitive decline and risk factors for progression to dementia in MCI‐LB and compare these to MCI due to Alzheimer's disease (MCI‐AD). Method: We included 194 MCI patients from the Amsterdam Dementia Cohort. MCI‐LB (n=73, 68±6yrs, 12%F, MMSE:27±2) was defined as MCI + (1)two or more core clinical features (hallucinations, parkinsonism, fluctuations, RBD), or (2)one core clinical feature and abnormal DAT‐SPECT and/or (3)probable Dementia with Lewy Bodies (DLB) at follow‐up. MCI‐AD (n=124, 68±7yrs, 48%F, MMSE:27±2) was defined as having MCI + abnormal CSF AD biomarkers. Cross‐sectional analyses included neuropsychiatric symptoms (GDS, NPI), caregiver burden (ZARIT), MRI, CSF biomarkers (tau/Ab1‐42 ratio) and APOE‐genotype. Annual follow‐up was available for 61 MCI‐LB patients and all MCI‐AD patients(3±2yrs). Linear mixed models(LMM) analyzed decline in MMSE and cognitive domains over time (memory, attention, executive and visuospatial functioning). Cox proportional‐hazards analyses identified risk factors for progression to dementia. Result: Parkinsonism was the most frequently reported feature in MCI‐LB (70%). In MCI‐LB, 33% had a CSF AD biomarker profile and 47% were APOE‐ɛ4 carrier. MCI‐LB patients scored higher on NPI, GDS and ZARIT than MCI‐AD. There were no differences in MRI characteristics(Table 1). MCI‐LB had lower baseline attention, executive and visuospatial functioning, while MCI‐AD had lower baseline memory scores. MCI‐LB declined faster over time on attention, whereas MCI‐AD had faster decline on MMSE and memory (Table 2, Figure 1). In MCI‐DLB, 53% progressed to DLB after 3±2 years. Posterior cortical atrophy(HR=3.0[1.5–5.8]) and lower attention(HR=1.6[1.1–2.3]) predicted shorter time to DLB(Figure 2). In MCI‐AD, 69% progressed to dementia after 3±2 years and lower executive functions(HR=1.3[1.0–1.6]) and memory(HR=1.1[1.0–1.2]) predicted faster progression to AD. Conclusion: MCI‐LB patients had more non‐cognitive symptoms, a distinct cognitive profile with prominent attentional decline and higher caregiver burden, compared to MCI‐AD. Attention impairment and posterior atrophy are potential risk factors for progression towards DLB. Our results underline the need for early diagnosis, since several of these symptoms already have impact in this disease stage and could be treated.