Despite being the second most common form of neurodegenerative dementia, dementia with Lewy bodies (DLB) is under-recognized and carries a worse prognosis than other subtypes of the condition. Cognitive impairment is a cardinal feature of all types of dementia and DLB presents with a distinct profile with deficits in attention, executive function, and visuoperceptual abilities. This difference from Alzheimer’s disease and the common presence of neuropsychiatric symptoms may lead to challenges in predicting cognitive decline in this patient population. Firstly, the diagnosis of DLB is often delayed in clinical practice leading to variability from which time point in the disease course cognitive decline is measured. Secondly, the most frequently used measurement tools for cognitive difficulties focus on memory and naming rather than the domains affected by DLB. While there is now largely a consensus which tools are useful in diagnosing DLB, their validity in assessing deteriorating cognition is less clear. Thirdly, the presence of fluctuating cognition, the propensity to develop delirium episodes, as well as difficulties in distinguishing the two entities in clinical practice make it difficult to predict the disease course. Sleep disturbances are likely to influence cognitive decline but require further study in patients within established DLB. Fourthly, as in most cases of dementia, neuropathological comorbidities are frequently present in DLB. While the influence of Alzheimer’s pathology on cognitive decline in DLB is comparatively well understood, the impact of other pathologies remains unclear. The recent definition of research criteria for mild cognitive impairment in DLB could facilitate earlier diagnosis and more structured follow-up. Assessment tools measuring cognitive domains predominantly affected in DLB need to be more consistently used in longitudinal studies and clinical practice, as well as concurrent measures of fluctuations in cognition. Greater availability of biomarkers and digital healthcare solutions can play an important role in enabling more accurate monitoring and prediction of cognitive decline in DLB.
Dement Geriatr Cogn Disord

中文翻译：

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用路易体预测痴呆症认知衰退的挑战

尽管是神经退行性痴呆的第二种最常见形式，但路易体痴呆 (DLB) 的认识不足，并且预后比该病的其他亚型更差。认知障碍是所有类型痴呆症的主要特征，DLB 表现出明显的特征，包括注意力、执行功能和视觉感知能力的缺陷。这种与阿尔茨海默病的差异以及神经精神症状的普遍存在可能导致在预测该患者群体的认知能力下降方面面临挑战。首先，DLB 的诊断在临床实践中经常被延迟，导致测量病程认知衰退的时间点的可变性。其次，认知困难最常用的测量工具侧重于记忆和命名，而不是受 DLB 影响的领域。虽然现在在很大程度上达成了共识，哪些工具可用于诊断 DLB，但它们在评估认知恶化方面的有效性尚不清楚。第三，认知波动的存在、谵妄发作的倾向以及临床实践中难以区分这两种实体，使得预测病程变得困难。睡眠障碍可能会影响认知能力下降，但需要对已建立 DLB 内的患者进行进一步研究。第四，与大多数痴呆病例一样，DLB 中经常存在神经病理学合并症。虽然阿尔茨海默病病理学对 DLB 认知能力下降的影响相对较好，但 其他病理的影响尚不清楚。最近对 DLB 中轻度认知障碍研究标准的定义可以促进早期诊断和更有条理的随访。测量主要受 DLB 影响的认知领域的评估工具需要更一致地用于纵向研究和临床实践，以及同时测量认知波动。生物标志物和数字医疗保健解决方案的更多可用性可以在更准确地监测和预测 DLB 的认知下降方面发挥重要作用。测量主要受 DLB 影响的认知领域的评估工具需要更一致地用于纵向研究和临床实践，以及同时测量认知波动。生物标志物和数字医疗保健解决方案的更多可用性可以在更准确地监测和预测 DLB 的认知衰退方面发挥重要作用。测量主要受 DLB 影响的认知领域的评估工具需要更一致地用于纵向研究和临床实践，以及同时测量认知波动。生物标志物和数字医疗保健解决方案的更多可用性可以在更准确地监测和预测 DLB 的认知下降方面发挥重要作用。
老年痴呆症认知障碍