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Neuropsychiatric symptoms and cognitive profile in mild cognitive impairment with Lewy bodies

Published online by Cambridge University Press:  24 January 2018

Paul C Donaghy ,
John-Paul Taylor ,
John T O'Brien ,
Nicola Barnett ,
Kirsty Olsen ,
Sean J Colloby ,
Jim Lloyd ,
George Petrides ,
Ian G McKeith  and
Alan J Thomas
Paul C Donaghy*
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
John-Paul Taylor
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
John T O'Brien
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
Nicola Barnett
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Kirsty Olsen
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Sean J Colloby
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Jim Lloyd
Affiliation:
Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
George Petrides
Affiliation:
Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Ian G McKeith
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Alan J Thomas
Affiliation:
Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
*
Author for correspondence: Dr Paul Donaghy, E-mail: paul.donaghy@ncl.ac.uk
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Abstract

Background

The accurate clinical characterisation of mild cognitive impairment (MCI) is becoming increasingly important. The aim of this study was to compare the neuropsychiatric symptoms and cognitive profile of MCI with Lewy bodies (MCI-LB) with Alzheimer's disease MCI (MCI-AD).

Methods

Participants were ⩾60 years old with MCI. Each had a thorough clinical and neuropsychological assessment and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single photon emission computed tomography FP-CIT SPECT). MCI-LB was diagnosed if two or more diagnostic features of dementia with Lewy bodies were present (visual hallucinations, cognitive fluctuations, motor parkinsonism, rapid eye movement sleep behaviour disorder or positive FP-CIT SPECT). A Lewy body Neuropsychiatric Supportive Symptom Count (LBNSSC) was calculated based on the presence or absence of the supportive neuropsychiatric symptoms defined by the 2017 DLB diagnostic criteria: non-visual hallucinations, delusions, anxiety, depression and apathy.

Results

MCI-LB (n = 41) had a higher LBNSSC than MCI-AD (n = 24; 1.8 ± 1.1 v. 0.7 ± 0.9, p = 0.001). 67% of MCI-LB had two or more of those symptoms, compared with 16% of MCI-AD (Likelihood ratio = 4.2, p < 0.001). MCI-LB subjects scored lower on tests of attention, visuospatial function and verbal fluency. However, cognitive test scores alone did not accurately differentiate MCI-LB from MCI-AD.

Conclusions

MCI-LB is associated with neuropsychiatric symptoms and a cognitive profile similar to established DLB. This supports the concept of identifying MCI-LB based on the presence of core diagnostic features of DLB and abnormal FP-CIT SPECT imaging. The presence of supportive neuropsychiatric clinical features identified in the 2017 DLB diagnostic criteria was helpful in differentiating between MCI-LB and MCI-AD.

Keywords

Dementia with Lewy bodiesmild cognitive impairmentneuropsychologyneuropsychiatric symptoms
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2384 - 2390
Copyright
Copyright © Cambridge University Press 2018 

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