Neuropsychological and clinical indicators of Lewy body and Alzheimer's pathology.

IF 2.8 Q2 NEUROSCIENCES
Journal of Alzheimer's disease reports Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI:10.1177/25424823241304386
Austin J Simpson, Kathryn A Wyman-Chick, Michael S Daniel
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引用次数: 0

Abstract

Background: Clinical distinction between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) poses significant challenges due to pathological comorbidity. Similar ages of onset and overlapping cognitive and psychiatric symptoms can lead to diagnostic inaccuracy and inappropriate treatment recommendations.

Objective: Identify the best combination of clinical and neuropsychological predictors of AD, DLB, and mixed DLB/AD neuropathology in dementia patients.

Methods: Using the National Alzheimer's Coordinating Center dataset, we selected either pure AD (n = 189), DLB (n = 21), or mixed DLB/AD (n = 42) patients on autopsy. Neuropsychological and clinical predictors, including core clinical features of DLB, were entered into multivariable logistic regressions.

Results: Gait disturbances (odds ratio (OR) = 19.32; p = 0.01), visual-spatial complaints (OR = 6.06; p = 0.03), and visual hallucinations (OR = 31.06; p = 0.002) predicted DLB compared to AD, along with better memory (OR = 3.42; p = 0.003), naming (OR = 3.35; p = 0.002), and worse processing speed (OR = 0.51; p = 0.01). When comparing DLB to DLB/AD, gait disturbances (OR = 6.33; p = 0.01), increased depressive symptoms (OR = 1.44; p = 0.03), and better memory (OR = 3.01; p = 0.004) predicted DLB. Finally, rapid eye movement sleep behavior disorder (RBD) (OR = 6.44; p = 0.004), parkinsonism severity (OR = 1.07; p = 0.02), and lower depressive symptoms (OR = 0.70; p = 0.006) and memory impairment (OR = 0.57; p = 0.02) distinguished DLB/AD from AD.

Conclusions: Our study converges with prior research suggesting specific neuropsychological and clinical features can help distinguish DLB from AD. Neuropsychological differentiation becomes more challenging among mixed pathologies and in advanced cognitive impairment, although the presence of RBD and parkinsonism distinguished DLB. Earlier clinical assessment and incorporation of in vivo and postmortem biomarkers should enhance diagnostic accuracy and understanding of disease characteristics, offering significant relevance for disease-modifying treatments.

路易体与阿尔茨海默病病理的神经心理、临床指标。
背景:阿尔茨海默病(AD)和伴路易体痴呆(DLB)的临床区分由于病理合并症而面临重大挑战。相似的发病年龄和重叠的认知和精神症状可导致诊断不准确和不适当的治疗建议。目的:确定痴呆患者AD、DLB及DLB/AD混合神经病理学的临床和神经心理学预测因子的最佳组合。方法:使用国家阿尔茨海默病协调中心的数据集,我们选择了尸检的纯AD (n = 189)、DLB (n = 21)或DLB/AD混合(n = 42)患者。神经心理学和临床预测因素,包括DLB的核心临床特征,被纳入多变量logistic回归。结果:步态障碍(优势比(OR) = 19.32;p = 0.01),视觉空间抱怨(OR = 6.06;p = 0.03),视幻觉(OR = 31.06;p = 0.002)预测DLB与AD相比,以及更好的记忆力(OR = 3.42;p = 0.003),命名(OR = 3.35;p = 0.002),处理速度更差(OR = 0.51;p = 0.01)。当DLB与DLB/AD比较时,步态障碍(OR = 6.33;p = 0.01),抑郁症状增加(OR = 1.44;p = 0.03),记忆力较好(OR = 3.01;p = 0.004)预测DLB。最后,快速眼动睡眠行为障碍(RBD) (OR = 6.44;p = 0.004),帕金森病严重程度(OR = 1.07;p = 0.02),抑郁症状较低(OR = 0.70;p = 0.006)和记忆障碍(OR = 0.57;p = 0.02)区分DLB/AD和AD。结论:我们的研究与先前的研究一致,表明特定的神经心理学和临床特征可以帮助区分DLB和AD。尽管RBD和帕金森病的存在可以区分DLB,但在混合病理和晚期认知障碍中,神经心理分化变得更具挑战性。早期的临床评估和体内和死后生物标志物的结合应该提高诊断的准确性和对疾病特征的理解,为改善疾病的治疗提供重要的相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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