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      Disease progression in dementia with Lewy bodies: A longitudinal study on clinical symptoms, quality of life and functional impairment

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          Abstract

          Background and Objectives

          Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL).

          Methods

          We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow‐up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL‐AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL‐AD).

          Results

          Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change β ± SE = −2.06 ± 0.23), QoL‐AD (−1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL‐AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co‐pathology (CSF pTau/Aβ42 ratio) was associated to steeper decline in MMSE (−1.23 ± 0.54). Medial temporal atrophy (−0.81 ± 0.26) and global cortical atrophy (−0.73 ± 0.36) predisposed for decline in QoL‐AD.

          Conclusions

          Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures.

          Key points

          • Clinical symptoms did not determine progression of cognitive functioning, IADL or quality of life (QoL).

          • Concomitant AD pathology and atrophy were determinants for progression in dementia with Lewy bodies.

          • Increasing severity of clinical symptoms was associated with cognitive decline and diminished QoL and functional abilities.

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          Most cited references42

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          Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.

          Christopher G. Goetz, Barbara C. Tilley, Stephanie Shaftman … (2008)
          We present a clinimetric assessment of the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The MDS-UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item-specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS-UPDRS (65 items) to 877 English speaking (78% non-Latino Caucasian) patients with Parkinson's disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS-UPDRS showed high internal consistency (Cronbach's alpha = 0.79-0.93 across parts) and correlated with the original UPDRS (rho = 0.96). MDS-UPDRS across-part correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS-UPDRS for rating PD.
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            Studies of interference in serial verbal reactions.

            J. R. Stroop (1935)
            Article 0 comments Cited 1314 times – based on 0 reviews     Review now
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              Diagnosis and management of dementia with Lewy bodies

              Ian G. McKeith, Bradley F. Boeve, Dennis W. Dickson … (2017)
              The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.
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                Author and article information

                Contributors
                Marleen van de Beek:
                ORCID: https://orcid.org/0000-0002-1619-073X
                m.vandebeek2@amsterdamumc.nl
                Journal
                Journal ID (nlm-ta): Int J Geriatr Psychiatry
                Journal ID (iso-abbrev): Int J Geriatr Psychiatry
                Journal ID (doi): 10.1002/(ISSN)1099-1166
                Journal ID (publisher-id): GPS
                Title: International Journal of Geriatric Psychiatry
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0885-6230
                ISSN (Electronic): 1099-1166
                Publication date (Electronic): 20 November 2022
                Publication date (Print): December 2022
                Volume: 37
                Issue: 12 ( doiID: 10.1002/gps.v37.12 )
                Electronic Location Identifier: 10.1002/gps.5839
                Affiliations
                [ 1 ] Department of Neurology Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
                [ 2 ] Department of Radiology and Nuclear Medicine Amsterdam UMC Amsterdam The Netherlands
                [ 3 ] Institutes of Neurology and Healthcare Engineering UCL London England UK
                [ 4 ] Department of Clinical Chemistry Neurochemistry Laboratory Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
                [ 5 ] Department of Epidemiology and Data Sciences Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam The Netherlands
                Author notes
                [*] [* ] Correspondence

                Marleen van de Beek, Department of Neurology, Alzheimer Center Amsterdam, Amsterdam UMC, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.

                Email: m.vandebeek2@ 123456amsterdamumc.nl

                Author information
                https://orcid.org/0000-0002-1619-073X
                Article
                Publisher ID: GPS5839
                DOI: 10.1002/gps.5839
                PMC ID: 9828829
                PubMed ID: 36403133
                SO-VID: d8d1e7f2-a80b-45e6-9318-b6b455e8d7f9
                Copyright © © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 April 2022
                Date accepted : 02 November 2022
                Page count
                Figures: 2, Tables: 3, Pages: 9, Words: 5621
                Categories
                Subject: Research Article
                Subject: Research Article
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:09.01.2023

                ScienceOpen disciplines: Geriatric medicine
                Keywords: dementia with lewy bodies,iadl,progression,quality of life
                Data availability:
                ScienceOpen disciplines: Geriatric medicine
                Keywords: dementia with lewy bodies, iadl, progression, quality of life

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