Co-pathology in Alzheimer's disease and Lewy body disease and its association with neuropsychiatric symptoms

IF 11.1 1区医学 Q1 CLINICAL NEUROLOGY

Alzheimer's & Dementia Pub Date : 2025-09-15 DOI:10.1002/alz.70693

Lucy L. Gibson, Lea T. Grinberg, Victor R. Paes, Christoph Mueller, Renata E. P. Leite, Paula Villela Nunes, Alberto F. O. Justo, Carlos A. Pasqualucci, Eduardo Ferriolli, Dag Aarsland, Claudia K. Suemoto

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引用次数: 0

Abstract

BACKGROUND

Mixed neuropathology is common in dementia, but the clinical implications for neuropsychiatric symptoms (NPSs) are not well characterized.

METHODS

In a population-based post mortem study, cases with Alzheimer's disease neuropathological change (ADNC) and Lewy body disease (LBD) were identified with any comorbid neuropathology (limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy neuropathological change (LATE-NC), cerebrovascular disease, LBD, and ADNC, respectively). Post mortem interviews collected information regarding NPSs and cognition to explore associations between each co-pathology and NPSs across the whole cohort, as well as in participants without dementia.

RESULTS

Co-existing neuropathology was frequent, even among individuals without clinical dementia. In cases with ADNC, comorbid neocortical LBD pathology was associated with hallucinations, regardless of cognitive status. However, ADNC co-pathology in LBD was linked to a greater NPS burden in the full cohort but not in individuals without dementia.

DISCUSSION

Lewy bodies are associated with hallucinations independent of cognitive impairment, whereas ADNC co-pathology may contribute to NPS only when widespread and associated with cognitive dysfunction.

Highlights

Neuropathological heterogeneity is high even in clinical stages without dementia.
Neocortical but not limbic or brainstem LBD co-pathology is associated with hallucinations.
LBs are associated with hallucinations independent of cognitive status.
ADNC co-pathology is not associated with NPSs in LBD without dementia.
LATE co-pathology is associated with increased risk of dementia but not NPS.
Vascular co-pathology is associated with increased risk of delusions in ADNC.

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阿尔茨海默病和路易体病的共同病理及其与神经精神症状的关系

背景：混合神经病理在痴呆中很常见，但神经精神症状（nps）的临床意义尚未得到很好的表征。方法：在一项基于人群的尸检研究中，阿尔茨海默病神经病理改变（ADNC）和路易体病（LBD）患者被鉴定为任何共病神经病理（边缘显性年龄相关交互反应dna结合蛋白43脑病神经病理改变（LATE-NC）、脑血管疾病、LBD和ADNC）。死后访谈收集了有关nps和认知的信息，以探索整个队列以及无痴呆参与者中每种共同病理与nps之间的联系。结果：即使在没有临床痴呆的个体中，共存的神经病理学也很常见。在ADNC病例中，无论认知状态如何，共病的新皮质LBD病理与幻觉有关。然而，在整个队列中，LBD的ADNC共病理与更大的NPS负担有关，但在没有痴呆的个体中则没有。路易小体与独立于认知障碍的幻觉有关，而ADNC共病理仅在广泛传播并与认知功能障碍相关时才可能导致NPS。即使在没有痴呆的临床阶段，神经病理异质性也很高。新皮质而非边缘或脑干LBD共病理与幻觉有关。LBs与独立于认知状态的幻觉有关。在无痴呆的LBD中，ADNC共病理与nps无关。LATE共病理与痴呆风险增加有关，但与NPS无关。血管共病理与ADNC妄想风险增加有关。

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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来源期刊

Alzheimer's & Dementia 医学-临床神经学

CiteScore

14.50

自引率

5.00%

发文量

299

审稿时长

3 months

期刊介绍： Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.