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van de Beek M, van Unnik A, van Steenoven I, van der Zande J, Barkhof F, Teunissen CE, van der Flier W, Lemstra AW. Disease progression in dementia with Lewy bodies: A longitudinal study on clinical symptoms, quality of life and functional impairment. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5839. [PMID: 36403133 PMCID: PMC9828829 DOI: 10.1002/gps.5839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Marleen van de Beek
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Annemartijn van Unnik
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Inger van Steenoven
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Jessica van der Zande
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam UMCAmsterdamThe Netherlands
- Institutes of Neurology and Healthcare EngineeringUCLLondonEnglandUK
| | - Charlotte E. Teunissen
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Wiesje van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and Data SciencesVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Afina W. Lemstra
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
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Morbelli S, Chincarini A, Brendel M, Rominger A, Bruffaerts R, Vandenberghe R, Kramberger MG, Trost M, Garibotto V, Nicastro N, Frisoni GB, Lemstra AW, van der Zande J, Pilotto A, Padovani A, Garcia-Ptacek S, Savitcheva I, Ochoa-Figueroa MA, Davidsson A, Camacho V, Peira E, Arnaldi D, Bauckneht M, Pardini M, Sambuceti G, Aarsland D, Nobili F. Metabolic patterns across core features in dementia with lewy bodies. Ann Neurol 2019; 85:715-725. [PMID: 30805951 DOI: 10.1002/ana.25453] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify brain regions whose metabolic impairment contributes to dementia with Lewy bodies (DLB) clinical core features expression and to assess the influence of severity of global cognitive impairment on the DLB hypometabolic pattern. METHODS Brain fluorodeoxyglucose positron emission tomography and information on core features were available in 171 patients belonging to the imaging repository of the European DLB Consortium. Principal component analysis was applied to identify brain regions relevant to the local data variance. A linear regression model was applied to generate core-feature-specific patterns controlling for the main confounding variables (Mini-Mental State Examination [MMSE], age, education, gender, and center). Regression analysis to the locally normalized intensities was performed to generate an MMSE-sensitive map. RESULTS Parkinsonism negatively covaried with bilateral parietal, precuneus, and anterior cingulate metabolism; visual hallucinations (VH) with bilateral dorsolateral-frontal cortex, posterior cingulate, and parietal metabolism; and rapid eye movement sleep behavior disorder (RBD) with bilateral parieto-occipital cortex, precuneus, and ventrolateral-frontal metabolism. VH and RBD shared a positive covariance with metabolism in the medial temporal lobe, cerebellum, brainstem, basal ganglia, thalami, and orbitofrontal and sensorimotor cortex. Cognitive fluctuations negatively covaried with occipital metabolism and positively with parietal lobe metabolism. MMSE positively covaried with metabolism in the left superior frontal gyrus, bilateral-parietal cortex, and left precuneus, and negatively with metabolism in the insula, medial frontal gyrus, hippocampus in the left hemisphere, and right cerebellum. INTERPRETATION Regions of more preserved metabolism are relatively consistent across the variegate DLB spectrum. By contrast, core features were associated with more prominent hypometabolism in specific regions, thus suggesting a close clinical-imaging correlation, reflecting the interplay between topography of neurodegeneration and clinical presentation in DLB patients. Ann Neurol 2019;85:715-725.
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Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences, University of Genoa
| | - Andrea Chincarini
- National Institute of Nuclear Physics (INFN), Genoa section, Genoa, Italy
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Belgium.,Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Belgium.,Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Maja Trost
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTLab, Geneva University
| | - Nicolas Nicastro
- Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland.,Department of Psychiatry, University of Cambridge, United Kingdom
| | - Giovanni B Frisoni
- LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Afina W Lemstra
- VU Medical Center Alzheimer Center, Amsterdam, The Netherlands
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS - S. Isidoro Hospital, Trescore Balneario (BG), Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Garcia-Ptacek
- Department of Clinical Geriatrics, division of Neurobiology, Care Sciences and Society, Karolinska Institutet.,Internal Medicine, section for Neurology, Sädersjukhuset, Stockholm, Sweden
| | - Irina Savitcheva
- Department of Radiology, Karolinska Institutet, Stockholm, Sweden
| | - Miguel A Ochoa-Figueroa
- Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping, Sweden.,Department of Diagnostic Radiology, Linköping University Hospital, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Annette Davidsson
- Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping, Sweden
| | - Valle Camacho
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Enrico Peira
- National Institute of Nuclear Physics (INFN), Genoa section, Genoa, Italy.,Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Dario Arnaldi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences, University of Genoa
| | - Matteo Pardini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences, University of Genoa
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
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