Fluctuating cognition is a complex and disabling symptom that is seen most frequently in the context of Lewy body dementias encompassing dementia with Lewy bodies and Parkinson's disease dementia. In fact, since their description over three decades ago, cognitive fluctuations have remained a core diagnostic feature of dementia with Lewy bodies, the second most common dementia in the elderly. In the absence of reliable biomarkers for Lewy body pathology, the inclusion of such patients in therapeutic trials depends on the accurate identification of such core clinical features. Yet despite their diagnostic relevance, cognitive fluctuations remain poorly understood, in part due to the lack of a cohesive clinical and scientific explanation of the phenomenon itself. Motivated by this challenge, the present review examines the history, clinical phenomenology and assessment of cognitive fluctuations in the Lewy body dementias. Based on these data, the key neuropsychological, neurophysiological and neuroimaging correlates of cognitive fluctuations are described and integrated into a novel testable heuristic framework from which new insights may be gained.

中文翻译：

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路易体痴呆的认知波动：走向病理生理学框架。

波动的认知是一种复杂且致残的症状，在路易体痴呆症（包括路易体痴呆症和帕金森氏病性痴呆）中最常见。实际上，自从三十多年前对它们的描述以来，认知波动一直是路易体痴呆症的核心诊断特征，而路易体是老年人中第二常见的痴呆症。在缺乏路易氏体病理学可靠的生物标记物的情况下，将这类患者纳入治疗试验取决于对此类核心临床特征的准确识别。尽管具有诊断意义，但认知波动仍然知之甚少，部分原因是该现象本身缺乏统一的临床和科学解释。受此挑战的影响，本次审查回顾了历史，路易体痴呆的临床现象学和认知波动评估。基于这些数据，描述了认知波动的关键神经心理学，神经生理学和神经影像学相关性，并将其整合到一个新颖的可测试启发式框架中，从中可以获取新的见解。