Abstract：
OBJECTIVE: Retrospective studies indicate that dementia with Lewy bodies (DLB) may be preceded by a mild cognitive impairment (MCI) prodrome. Research criteria for the prospective identification of MCI with Lewy bodies (MCI-LB) have been developed. We aimed to assess the prognosis of a prospectively identified MCI-LB cohort at 2 key milestones, 3- and 5 years after diagnosis, to examine classification stability over time and rates of adverse outcomes (dementia or death).
METHODS: This was a retrospective examination of data from 2 longitudinal observational cohort studies where participants with MCI were prospectively recruited from North East England and differentially classified as MCI due to Alzheimer disease (MCI-AD), possible MCI-LB, or probable MCI-LB. Adverse outcomes (DLB/other dementia or death) and stability of disease-specific classifications were examined in each group.
RESULTS: Of 152 participants with baseline MCI (54 MCI-AD, 29 possible MCI-LB, and 69 probable MCI-LB), 126 were followed for up to 3 years (mean age 75.3 years; 40% female). We found that prospective probable MCI-LB classifications were both sensitive (91%) and specific (94%) to classifications either remaining as probable MCI-LB or progressing to DLB (in some cases autopsy confirmed) for 3 or more years after. Classifications were at least as stable as those in MCI-AD. In this cohort with disease-specific MCI classifications, rates of progression to dementia were high: 55% of MCI-LB had developed DLB within 3 years. Dementia occurred in 47% of MCI-AD over the same duration (odds ratio 1.68, 95% CI 0.66-4.26, p = 0.278). Premature death was a common competing risk, occurring in 9% of MCI-AD and 11% of MCI-LB within 3 years.
CONCLUSIONS: These findings support that prospectively identified probable MCI-LB is a prodromal presentation of DLB and that disease-specific classifications of MCI may reliably identify different prodromal dementias.
METHODS: This was a retrospective examination of data from 2 longitudinal observational cohort studies where participants with MCI were prospectively recruited from North East England and differentially classified as MCI due to Alzheimer disease (MCI-AD), possible MCI-LB, or probable MCI-LB. Adverse outcomes (DLB/other dementia or death) and stability of disease-specific classifications were examined in each group.
RESULTS: Of 152 participants with baseline MCI (54 MCI-AD, 29 possible MCI-LB, and 69 probable MCI-LB), 126 were followed for up to 3 years (mean age 75.3 years; 40% female). We found that prospective probable MCI-LB classifications were both sensitive (91%) and specific (94%) to classifications either remaining as probable MCI-LB or progressing to DLB (in some cases autopsy confirmed) for 3 or more years after. Classifications were at least as stable as those in MCI-AD. In this cohort with disease-specific MCI classifications, rates of progression to dementia were high: 55% of MCI-LB had developed DLB within 3 years. Dementia occurred in 47% of MCI-AD over the same duration (odds ratio 1.68, 95% CI 0.66-4.26, p = 0.278). Premature death was a common competing risk, occurring in 9% of MCI-AD and 11% of MCI-LB within 3 years.
CONCLUSIONS: These findings support that prospectively identified probable MCI-LB is a prodromal presentation of DLB and that disease-specific classifications of MCI may reliably identify different prodromal dementias.
摘要：
目的：回顾性研究表明，路易体痴呆（DLB）可能先于轻度认知障碍（MCI）前驱症状。已经开发了具有路易体的MCI（MCI-LB）的前瞻性鉴定的研究标准。我们旨在评估2个关键里程碑的前瞻性MCI-LB队列的预后。诊断后3年和5年，检查分类随时间的稳定性和不良结局（痴呆或死亡）的发生率。
方法：本研究是对来自2项纵向观察性队列研究的数据的回顾性研究，其中MCI患者从英格兰东北部前瞻性招募，并将其分类为阿尔茨海默病（MCI-AD）所致的MCI。可能的MCI-LB，或可能的MCI-LB。在每组中检查不良结果(DLB/其他痴呆或死亡)和疾病特异性分类的稳定性。
结果：在152名具有基线MCI的参与者中（54名MCI-AD，29可能的MCI-LB，和69可能的MCI-LB），126例随访3年（平均年龄75.3岁；40%为女性）。我们发现，前瞻性可能的MCI-LB分类对分类敏感（91％）和特异性（94％），要么保留为可能的MCI-LB，要么在3年或更长时间后发展为DLB（在某些情况下尸检证实）。分类至少与MCI-AD中的分类一样稳定。在这个具有疾病特异性MCI分类的队列中，进展为痴呆的比率很高:55%的MCI-LB在3年内发展为DLB.在相同持续时间内，有47％的MCI-AD发生了痴呆（比值比1.68，95％CI0.66-4.26，p=0.278）。过早死亡是一种常见的竞争风险，在3年内发生在9％的MCI-AD和11％的MCI-LB中。
结论：这些发现支持前瞻性鉴定可能的MCI-LB是DLB的前驱表现，并且MCI的疾病特异性分类可以可靠地鉴定不同的前驱痴呆。
方法：本研究是对来自2项纵向观察性队列研究的数据的回顾性研究，其中MCI患者从英格兰东北部前瞻性招募，并将其分类为阿尔茨海默病（MCI-AD）所致的MCI。可能的MCI-LB，或可能的MCI-LB。在每组中检查不良结果(DLB/其他痴呆或死亡)和疾病特异性分类的稳定性。
结果：在152名具有基线MCI的参与者中（54名MCI-AD，29可能的MCI-LB，和69可能的MCI-LB），126例随访3年（平均年龄75.3岁；40%为女性）。我们发现，前瞻性可能的MCI-LB分类对分类敏感（91％）和特异性（94％），要么保留为可能的MCI-LB，要么在3年或更长时间后发展为DLB（在某些情况下尸检证实）。分类至少与MCI-AD中的分类一样稳定。在这个具有疾病特异性MCI分类的队列中，进展为痴呆的比率很高:55%的MCI-LB在3年内发展为DLB.在相同持续时间内，有47％的MCI-AD发生了痴呆（比值比1.68，95％CI0.66-4.26，p=0.278）。过早死亡是一种常见的竞争风险，在3年内发生在9％的MCI-AD和11％的MCI-LB中。
结论：这些发现支持前瞻性鉴定可能的MCI-LB是DLB的前驱表现，并且MCI的疾病特异性分类可以可靠地鉴定不同的前驱痴呆。
