Background:

Research criteria for prodromal dementia with Lewy bodies (DLB) were published in 2020, but little is known regarding prodromal DLB in clinical settings.

Methods:

We identified non-demented participants without neurodegenerative disease from the National Alzheimer’s Coordinating Center Uniform Data Set who converted to DLB at a subsequent visit. Prevalence of neuropsychiatric and motor symptoms were examined up to 5 years prior to DLB diagnosis.

Results:

The sample included 116 participants clinically diagnosed with DLB and 348 age and sex-matched (1:3) Healthy Controls. Motor slowing was present in approximately 70% of participants 3 years prior to DLB diagnosis. In the prodromal phase, 50% of DLB participants demonstrated gait disorder, 70% had rigidity, 20% endorsed visual hallucinations, and over 50% of participants endorsed REM sleep behavior disorder. Apathy, depression, and anxiety were common prodromal neuropsychiatric symptoms. The presence of 1+ core clinical features of DLB in combination with apathy, depression, or anxiety resulted in the greatest AUC (0.815; 95% CI: 0.767, 0.865) for distinguishing HC from prodromal DLB 1 year prior to diagnosis. The presence of 2+ core clinical features was also accurate in differentiating between groups (AUC = 0.806; 95% CI: 0.756, 0.855).

Conclusion:

A wide range of motor, neuropsychiatric and other core clinical symptoms are common in prodromal DLB. A combination of core clinical features, neuropsychiatric symptoms and cognitive impairment can accurately differentiate DLB from normal aging prior to dementia onset.

中文翻译：

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路易体前驱痴呆：症状的演变和痴呆发作的预测因素

背景：

路易体前驱性痴呆 (DLB) 的研究标准于 2020 年发布，但对于临床环境中的前驱性 DLB 知之甚少。

方法：

我们从国家阿尔茨海默病协调中心统一数据集中确定了没有神经退行性疾病的非痴呆参与者，他们在随后的访问中转换为 DLB。在 DLB 诊断前 5 年检查了神经精神和运动症状的患病率。

结果：

该样本包括 116 名临床诊断为 DLB 的参与者和 348 名年龄和性别匹配 (1:3) 的健康对照者。在 DLB 诊断前 3 年，大约 70% 的参与者存在运动减慢。在前驱期，50% 的 DLB 参与者表现出步态障碍，70% 有僵硬，20% 认可视幻觉，超过 50% 的参与者认可 REM 睡眠行为障碍。冷漠、抑郁和焦虑是常见的前驱神经精神症状。DLB 的 1+ 核心临床特征的存在以及冷漠、抑郁或焦虑导致诊断前 1 年区分 HC 和前驱 DLB 的最大 AUC（0.815；95% CI：0.767，0.865）。2+ 核心临床特征的存在也可以准确区分组（AUC = 0.806；95% CI：0.756，0.855）。

结论：

广泛的运动、神经精神和其他核心临床症状在前驱 DLB 中很常见。结合核心临床特征、神经精神症状和认知障碍，可以准确地区分 DLB 与痴呆发作前的正常衰老。