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Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease

Published online by Cambridge University Press:  05 May 2020

Calum A. Hamilton Open the ORCID record for Calum A. Hamilton [Opens in a new window] ,
Fiona E. Matthews Open the ORCID record for Fiona E. Matthews [Opens in a new window] ,
Paul C. Donaghy ,
John-Paul Taylor ,
John T. O'Brien ,
Nicola Barnett ,
Kirsty Olsen ,
Ian G. McKeith  and
Alan J. Thomas
Calum A. Hamilton*
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
Fiona E. Matthews
Affiliation:
Population Health Sciences Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
Paul C. Donaghy
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
John-Paul Taylor
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
John T. O'Brien
Affiliation:
Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SZ, UK
Nicola Barnett
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
Kirsty Olsen
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
Ian G. McKeith
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
Alan J. Thomas
Affiliation:
Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
*
Author for correspondence: Calum A. Hamilton, E-mail: [email protected]
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Abstract

Background

Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD).

Methods

A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function.

Results

Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline.

Conclusions

These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms – particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.

Keywords

Alzheimer's diseasedementia with Lewy bodieslatent class mixture modellinglongitudinal declinemild cognitive impairment
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 15 , November 2021 , pp. 2590 - 2598
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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