Cognitive function, psychobehavioral symptoms, and MRI features in patients with non-demented Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Parkinsonism & related disorders Pub Date : 2025-07-07 DOI:10.1016/j.parkreldis.2025.107953

Tian Xu , Yong Ji , Pan Wang , Hao Wu , Shuai Liu , Zhaoyang Lv , Xiaoqiao Ren , Jia Liu , Zihan Wang , Hao Lu , Zhihong Shi

{"title":"Cognitive function, psychobehavioral symptoms, and MRI features in patients with non-demented Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies","authors":"Tian Xu , Yong Ji , Pan Wang , Hao Wu , Shuai Liu , Zhaoyang Lv , Xiaoqiao Ren , Jia Liu , Zihan Wang , Hao Lu , Zhihong Shi","doi":"10.1016/j.parkreldis.2025.107953","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease without dementia (PD-ND), Parkinson's disease with dementia (PDD), and dementia with Lewy bodies (DLB) are Lewy body disorders characterized by intraneuronal Lewy body pathology. Although the sequence of motor and cognitive symptom onset assists in differentiating PDD from DLB, overlapping clinical features often complicate diagnosis. This study compared cognitive profiles, neuropsychiatric symptoms, and magnetic resonance imaging (MRI) characteristics among PD-ND, PDD, and DLB to identify potential diagnostic markers.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 213 patients with PD-ND, 85 with PDD, 140 with DLB, and 86 age-matched cognitively normal controls seen between 2011 and 2025. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Neuropsychiatric symptoms and MRI visual rating scales, including ventricular enlargement, global cortical atrophy, medial temporal atrophy, parietal atrophy (Koedam score), white matter hyperintensities, Fazekas scale, Evans Index, and width of the third ventricle, were evaluated.</div></div><div><h3>Results</h3><div>PDD patients exhibited longer disease duration than those with DLB (P < 0.001). DLB cases demonstrated lower MMSE and MoCA scores and greater neuropsychiatric symptom severity (all P < 0.01). DLB showed more extensive structural brain changes compared to both PD-ND and PDD. A combined imaging model yielded an AUC of 0.768.</div></div><div><h3>Conclusion</h3><div>DLB is associated with more rapid cognitive decline, greater neuropsychiatric burden, and more pronounced atrophy compared to PDD. Combined imaging measures may improve differential diagnosis.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"138 ","pages":"Article 107953"},"PeriodicalIF":3.1000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Parkinsonism & related disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1353802025006947","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Parkinson's disease without dementia (PD-ND), Parkinson's disease with dementia (PDD), and dementia with Lewy bodies (DLB) are Lewy body disorders characterized by intraneuronal Lewy body pathology. Although the sequence of motor and cognitive symptom onset assists in differentiating PDD from DLB, overlapping clinical features often complicate diagnosis. This study compared cognitive profiles, neuropsychiatric symptoms, and magnetic resonance imaging (MRI) characteristics among PD-ND, PDD, and DLB to identify potential diagnostic markers.

Methods

A retrospective review was conducted of 213 patients with PD-ND, 85 with PDD, 140 with DLB, and 86 age-matched cognitively normal controls seen between 2011 and 2025. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Neuropsychiatric symptoms and MRI visual rating scales, including ventricular enlargement, global cortical atrophy, medial temporal atrophy, parietal atrophy (Koedam score), white matter hyperintensities, Fazekas scale, Evans Index, and width of the third ventricle, were evaluated.

Results

PDD patients exhibited longer disease duration than those with DLB (P < 0.001). DLB cases demonstrated lower MMSE and MoCA scores and greater neuropsychiatric symptom severity (all P < 0.01). DLB showed more extensive structural brain changes compared to both PD-ND and PDD. A combined imaging model yielded an AUC of 0.768.

Conclusion

DLB is associated with more rapid cognitive decline, greater neuropsychiatric burden, and more pronounced atrophy compared to PDD. Combined imaging measures may improve differential diagnosis.

查看原文本刊更多论文

非痴呆性帕金森病、帕金森病伴痴呆和伴路易体痴呆患者的认知功能、心理行为症状和MRI特征

无痴呆性帕金森病（PD-ND）、伴痴呆性帕金森病（PDD）和伴路易体痴呆（DLB）是以神经元内路易体病理为特征的路易体疾病。虽然运动和认知症状的发作顺序有助于区分PDD和DLB，但重叠的临床特征往往使诊断复杂化。本研究比较了PD-ND、PDD和DLB患者的认知特征、神经精神症状和磁共振成像（MRI）特征，以确定潜在的诊断标志物。方法回顾性分析2011年至2025年间的213例PD-ND患者、85例PDD患者、140例DLB患者和86例年龄匹配的认知正常对照。认知表现采用简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）进行评估。评估神经精神症状和MRI视觉评定量表，包括脑室增大、整体皮质萎缩、内侧颞叶萎缩、顶叶萎缩（Koedam评分）、白质高信号、Fazekas评分、Evans指数和第三脑室宽度。结果spdd患者病程较DLB患者长(P <；0.001)。DLB患者表现出较低的MMSE和MoCA评分和较高的神经精神症状严重程度(P <；0.01)。与PD-ND和PDD相比，DLB表现出更广泛的大脑结构改变。联合成像模型的AUC为0.768。结论与PDD相比，dlb认知能力下降更快，神经精神负担更重，萎缩更明显。联合影像学检查可改善鉴别诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Parkinsonism & related disorders 医学-临床神经学

CiteScore

6.20

自引率

4.90%

发文量

292

审稿时长

39 days

期刊介绍： Parkinsonism & Related Disorders publishes the results of basic and clinical research contributing to the understanding, diagnosis and treatment of all neurodegenerative syndromes in which Parkinsonism, Essential Tremor or related movement disorders may be a feature. Regular features will include: Review Articles, Point of View articles, Full-length Articles, Short Communications, Case Reports and Letter to the Editor.