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Mild cognitive impairment with Lewy bodies: neuropsychiatric supportive symptoms and cognitive profile

Published online by Cambridge University Press:  25 August 2020

Paul C Donaghy Open the ORCID record for Paul C Donaghy [Opens in a new window] ,
Joanna Ciafone ,
Rory Durcan ,
Calum A Hamilton ,
Sally Barker ,
Jim Lloyd ,
Michael Firbank ,
Louise M Allan ,
John T O'Brien  and
John-Paul Taylor
...Show all authors
Paul C Donaghy*
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Joanna Ciafone
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Rory Durcan
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Calum A Hamilton
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Sally Barker
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Jim Lloyd
Affiliation:
Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Michael Firbank
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Louise M Allan
Affiliation:
College of Medicine and Health, Exeter University, Exeter, UK
John T O'Brien
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
John-Paul Taylor
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Alan J Thomas
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
*
Author for correspondence: Paul C Donaghy, E-mail: [email protected]
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Abstract

Background

Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort.

Methods

Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis.

Results

Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD.

Conclusions

MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.

Keywords

AgitationAnxietyApathyCognitionDementia with Lewy bodiesDepressionMCIMild cognitive impairment with Lewy bodiesNeuropsychiatric symptoms
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1147 - 1155
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., … Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 270–279. doi:10.1016/j.jalz.2011.03.008.CrossRefGoogle Scholar
Ballard, C., O'Brien, J., Gray, A., Cormack, F., Ayre, G., Rowan, E., … Tovee, M. (2001). Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease. Archives of Neurology, 58, 977–982.CrossRefGoogle ScholarPubMed
Benamer, T. S., Patterson, J., Grosset, D. G., Booij, J., de Bruin, K., van Royen, E., … Ries, V. (2000). Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: The [123I]-FP-CIT study group. Movement Disorders, 15, 503–510.3.0.CO;2-V>CrossRefGoogle Scholar
Bertrand, R. M., Willis, S. L., & Sayer, A. (2001). An evaluation of change over time in everyday cognitive competence among Alzheimer's patients. Aging Neuropsychology and Cognition, 8, 192–212. doi:10.1076/anec.8.3.192.830.CrossRefGoogle Scholar
Boeve, B. F., Molano, J. R., Ferman, T. J., Smith, G. E., Lin, S.-C., Bieniek, K., … Silber, M. H. (2011). Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Medicine, 12, 445–453. doi:10.1016/j.sleep.2010.12.009.CrossRefGoogle Scholar
Borkowski, J. G., Benton, A. L., & Spreen, O. (1966). Word fluency and brain damage. Neuropsychologia, 5, 135–140.CrossRefGoogle Scholar
Cagnin, A., Busse, C., Gardini, S., Jelcic, N., Guzzo, C., Gnoato, F., … Caffarra, P. (2015). Clinical and cognitive phenotype of mild cognitive impairment evolving to dementia with Lewy bodies. Dementia and Geriatric Cognitive Disorders Extra, 5, 442–449. doi:10.1159/000441184..CrossRefGoogle ScholarPubMed
Ciafone, J., Little, B., Thomas, A. J., & Gallagher, P. (2020). The neuropsychological profile of mild cognitive impairment in Lewy body dementias Journal of the International Neuropsychological Society, 26, 210–225. doi:10.1017/S1355617719001103.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
D'Ath, P., Katona, P., Mullan, E., Evans, S., & Katona, C, (1994). Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Family Practice, 11, 260–266.CrossRefGoogle ScholarPubMed
Donaghy, P. C., Taylor, J. P., O'Brien, J. T., Barnett, N., Olsen, K., Colloby, S. J., … Thomas, A. J. (2018). Neuropsychiatric symptoms and cognitive profile in mild cognitive impairment with Lewy bodies. Psychological Medicine, 48, 2384–2390. doi:10.1017/S0033291717003956..CrossRefGoogle ScholarPubMed
Ferman, T. J., Smith, G. E., Kantarci, K., Boeve, B. F., Pankratz, V. S., Dickson, D. W., … Petersen, R. C. (2013). Nonamnestic mild cognitive impairment progresses to dementia with Lewy bodies. Neurology, 81, 2032–2038. doi:10.1212/01.wnl.0000436942.55281.47.CrossRefGoogle ScholarPubMed
Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez-Martin, P., ... Movement Disorder Society, U. R. T. F. (2008). Movement Disorder Society sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Movement Disorders : Official Journal of the Movement Disorder Society, 23, 2129–2170.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry: The Journal of Mental Science, 140, 566–572.CrossRefGoogle ScholarPubMed
Ismail, Z., Smith, E. E., Geda, Y., Sultzer, D., Brodaty, H., Smith, G., … Area, I. N. S. P. I. (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment. 12, 195–202. doi:10.1016/j.jalz.2015.05.017.CrossRefGoogle Scholar
Kane, J. P. M., Surendranathan, A., Bentley, A., Barker, S. A. H., Taylor, J. P., Thomas, A. J., … O'Brien, J. T. (2018). Clinical prevalence of Lewy body dementia. Alzheimer's Research & Therapy, 10, 19. doi: 10.1186/s13195-018-0350-6.CrossRefGoogle ScholarPubMed
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lee, D. R., Mckeith, I, Mosimann, U., Ghosh-Nodial, A., Grayson, L., Wilson, B., & Thomas, A. J. (2014). The dementia cognitive fluctuation scale, a new psychometric test for clinicians to identify cognitive fluctuations in people with dementia. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 22, 926–935.CrossRefGoogle ScholarPubMed
Litvan, I., Goldman, J. G., Troster, A. I., Schmand, B. A., Weintraub, D., Petersen, R. C., … Emre, M. (2012). Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines. Movement Disorders, 27, 349–356. doi:10.1002/mds.24893.CrossRefGoogle ScholarPubMed
Livingston, G., Manela, M., O'Keeffe, A., Rapaport, P., Cooper, C., Knapp, M., … Barber, J. (2020). Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6–year follow-up of a randomised controlled trial. British Journal of Psychiatry, 2016, 35–42. doi:10.1192/bjp.2019.160.CrossRefGoogle Scholar
McKeith, I. G., Boeve, B. F., Dickson, D. W., Halliday, G., Taylor, J. P., Weintraub, D., … Kosaka, K. (2017). Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology, 89, 88–100. doi:10.1212/WNL.0000000000004058.CrossRefGoogle ScholarPubMed
McKeith, I. G., Ferman, T. J., Thomas, A. J., Blanc, F., Boeve, B. F., Fujishiro, H., … Tiraboschi, P. (2020). Research criteria for the diagnosis of prodromal dementia with Lewy bodies. Neurology, 94, 743–755.CrossRefGoogle Scholar
McKenna, P., & Warrington, E. K. (2007). Graded naming test: Object picture book. Cambridge: Cambridge Cognition Ltd.Google Scholar
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R., & Hodges, J. R. (2006). The Addenbrooke's Cognitive Examination Revised (ACE-R): A brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078–1085. doi: 10.1002/gps.1610.CrossRefGoogle ScholarPubMed
Reitan, R. M. (1955). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology, 19, 393–394.CrossRefGoogle ScholarPubMed
Rey, A. (1964). L'examen clinique en psychologie. Paris: Presses Universitaires de France.Google Scholar
Roberts, G., Lloyd, J. J., Kane, J. P. M., Durcan, R., Lawley, S., Howe, K., … Thomas, A. J. (2019). Cardiac (123)I-MIBG normal uptake values are population-specific: Results from a cohort of controls over 60 years of age. Journal of Nuclear Cardiology. Online ahead of print. doi:10.1007/s12350-019-01887-6.Google ScholarPubMed
Sadiq, D., Whitfield, T., Lee, L., Stevens, T., Costafreda, S., & Walker, Z. (2017). Prodromal dementia with Lewy bodies and prodromal Alzheimer's disease: A comparison of the cognitive and clinical profiles. Journal of Alzheimer's Disease, 58, 463–470. doi:10.3233/JAD-161089.CrossRefGoogle ScholarPubMed
Schumacher, J., Cromarty, R., Gallagher, P., Firbank, M. J., Thomas, A. J., Kaiser, M., … Taylor, J. P. (2019). Structural correlates of attention dysfunction in Lewy body dementia and Alzheimer's disease: An ex-Gaussian analysis. 266, 1716–1726. doi:10.1007/s00415-019-09323-y.CrossRefGoogle Scholar
Seppi, K., Ray Chaudhuri, K., Coelho, M., Fox, S. H., Katzenschlager, R., Perez Lloret, S., … the collaborators of the Parkinson's Disease Update on Non-Motor Symptoms Study Group on behalf of the Movement Disorders Society Evidence-Based Medicine, C. (2019). Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review. 34, 180–198. doi:10.1002/mds.27602.CrossRefGoogle Scholar
Svendsboe, E., Terum, T., Testad, I., Aarsland, D., Ulstein, I., Corbett, A., & Rongve, A. (2016). Caregiver burden in family carers of people with dementia with Lewy bodies and Alzheimer's disease. 31, 1075–1083. doi:10.1002/gps.4433.CrossRefGoogle Scholar
Taylor, J. P., McKeith, I. G., Burn, D. J., Boeve, B. F., Weintraub, D., Bamford, C., … O'Brien, J. T. (2020). New evidence on the management of Lewy body dementia. 19, 157–169. doi:10.1016/S1474-4422(19)30153-X.CrossRefGoogle Scholar
Walker, M. P., Ayre, G. A., Cummings, J. L., Wesnes, K., Mckeith, I, O'brien, J. T., & Ballard, C. G. (2000). The clinician assessment of fluctuation and the one day fluctuation assessment scale. Two methods to assess fluctuating confusion in dementia. The British Journal of Psychiatry: The Journal of Mental Science, 177, 252–256.CrossRefGoogle ScholarPubMed
Wood, J. S., Firbank, M. J., Mosimann, U. P., Watson, R., Barber, R., Blamire, A. M., & O'Brien, J. T. (2013). Testing visual perception in dementia with Lewy bodies and Alzheimer disease. The American Journal of Geriatric Psychiatry, 21, 501–508. doi: 10.1016/j.jagp.2012.11.015.CrossRefGoogle ScholarPubMed
Yoon, J. H., Kim, M., Moon, S. Y., Yong, S. W., & Hong, J. M. (2015). Olfactory function and neuropsychological profile to differentiate dementia with Lewy bodies from Alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study. Journal of the Neurological Sciences, 355, 174–179. doi:10.1016/j.jns.2015.06.013.CrossRefGoogle ScholarPubMed
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