Mild cognitive impairment with Lewy bodies: neuropsychiatric supportive symptoms and cognitive profile

Abstract Background Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort. Methods Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis. Results Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD. Conclusions MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.

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

Psychological Medicine ◽

10.1017/s0033291717003956 ◽

2018 ◽

Vol 48 (14) ◽

pp. 2384-2390 ◽

Cited By ~ 24

Author(s):

Paul C Donaghy ◽

John-Paul Taylor ◽

John T O'Brien ◽

Nicola Barnett ◽

Kirsty Olsen ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Neuropsychiatric Symptoms ◽

Lewy Bodies ◽

Cognitive Profile ◽

Cognitive Test ◽

Emission Computed Tomography ◽

Visual Hallucinations ◽

Diagnostic Features

AbstractBackgroundThe 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).MethodsParticipants 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.ResultsMCI-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.ConclusionsMCI-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.

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Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies

Neurology ◽

10.1212/wnl.0000000000012060 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012060

Author(s):

Gemma Roberts ◽

Rory Durcan MRCPI ◽

Paul C Donaghy ◽

Sarah Lawley ◽

Joanna Ciafone ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Likelihood Ratio ◽

Lewy Bodies ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Mibg Scintigraphy ◽

Core Feature ◽

Clinical Diagnoses ◽

Core Features

ObjectiveTo provide evidence that cardiac mIBG scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from MCI due to Alzheimer’s disease (MCI-AD) we scanned patients with MCI and obtained consensus clinical diagnoses of their MCI subtype. We also performed baseline FP-CIT scans to compare the accuracy of mIBG and FP-CIT.MethodsWe conducted a prospective cohort study into the accuracy of cardiac mIBG scintigraphy in the diagnosis of MCI-LB. Follow up clinical assessment was used to diagnose MCI-AD (no core features of MCI-LB and normal FP-CIT); probable MCI-LB (2 or more core features, or 1 core feature with abnormal FP-CIT) or possible MCI-LB (1 core feature or abnormal FP-CIT). For the comparison between mIBG and FP-CIT, only core clinical features were used for diagnosis.ResultsWe recruited 95 people with mild cognitive impairment. Cardiac mIBG was abnormal in 22/37 probable and 2/15 possible MCI-LB cases and normal in 38/43 MCI-AD. The sensitivity in probable MCI-LB was 59% (95% CI 42 to 75%), specificity 88% (75 to 96%) and accuracy 75% (64 to 84%). The positive likelihood ratio was 5.1 and negative likelihood ratio 0.46. With symptom-only diagnoses, the accuracies were 79% for mIBG (95% CI: 68 to 87%) and 76% for FP-CIT (95% CI: 65 to 85%).ConclusionsCardiac mIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicentre setting is justified.Classification of EvidenceThis study provides Class I evidence that cardiac mIBG distinguishes MCI-LB from MCI-AD.

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Research criteria for the diagnosis of prodromal dementia with Lewy bodies

Neurology ◽

10.1212/wnl.0000000000009323 ◽

2020 ◽

Vol 94 (17) ◽

pp. 743-755 ◽

Cited By ~ 31

Author(s):

Ian G. McKeith ◽

Tanis J. Ferman ◽

Alan J. Thomas ◽

Frédéric Blanc ◽

Bradley F. Boeve ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Sufficient Information ◽

Evidence Based ◽

Prodromal Phase ◽

Research Criteria ◽

Prodromal Dementia

The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.

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Mild Cognitive Impairment: Diagnosis and Subtypes

Clinical EEG and Neuroscience ◽

10.1177/15500594211042708 ◽

2021 ◽

pp. 155005942110427

Author(s):

Nicholas I. Bradfield

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Lewy Bodies ◽

Vascular Cognitive Impairment ◽

Cognitive Domain ◽

Subjective Cognitive Decline ◽

Increased Risk ◽

Risk Of Progression ◽

History Of

Mild cognitive impairment (MCI) is a clinical diagnosis based on subjective cognitive decline, objective cognitive impairment, and relative preservation of activities of daily living. The diagnosis may be established via clinical interview, collateral history from an informant, and psychometric examination. Various consensus groups have proposed criteria for MCI in Alzheimer's disease (AD), Parkinson's disease, dementia with Lewy bodies, and vascular cognitive impairment. These diagnostic criteria have subtle but important differences. Criteria for subjective decline vary according to whether memory is impaired or whether impairment in any cognitive domain is sufficient. There are also differences with respect to whether the subjective decline is noted by the patient, a carer, or a clinician. The precise thresholds for classifying objective cognitive impairment also vary between various diagnostic criteria. There are also differences in the description of functional abilities. Once established, the diagnosis of MCI may be refined to 1 of 4 subtypes based on the pattern of cognitive impairment. The 4 subtypes are defined according to whether or not memory is impaired and whether 1 or more cognitive domains are impaired. Once a diagnosis of MCI has been made, the patient and their family should be counseled about social and legal implications as well as strategies for reducing the risk of progression to dementia. The main utilities of MCI as a nosology are to understand the natural history of neurodegenerative disorders such as AD, to identify those at increased risk of progressing to develop dementia, and to identifying individuals for putative treatments.

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The Impact of the COVID-19 Pandemic and Lockdown on Mild Cognitive Impairment, Alzheimer's Disease and Dementia With Lewy Bodies in China: A 1-Year Follow-Up Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.711658 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhi-Chao Chen ◽

Shuai Liu ◽

Jinghuan Gan ◽

Lingyun Ma ◽

Xiaoshan Du ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Dementia With Lewy Bodies ◽

Neuropsychiatric Symptoms ◽

Lewy Bodies ◽

Social Contact ◽

The Impact

Background: While the lockdown strategies taken by many countries effectively limited the spread of COVID-19, those were thought to have a negative impact on older people. This study aimed to investigate the impact of lockdown on cognitive function and neuropsychiatric symptoms over a 1-year follow-up period in patients with mild cognitive impairment (MCI), Alzheimer's disease (AD) and dementia with Lewy bodies (DLB).Methods: We enrolled consecutive patients with MCI, probable AD or DLB who were receiving outpatient memory care before the COVID-19 pandemic and followed-up with them after 1 year by face-to-face during the COVID-19 pandemic to assess changes in physical activity, social contact, cognitive function and neuropsychiatric symptoms (NPS).Results: Total 105 probable AD, 50 MCI and 22 probable DLB patients were included and completed the 1-year follow-up between October 31 and November 30, 2020. Among the respondents, 42% of MCI, 54.3% of AD and 72.7% of DLB patients had a decline in MMSE scores and 54.4% of DLB patients had worsening Neuropsychiatric inventory (NPI) scores. Patients with DLB showed a more rapid decline of MMSE than those with AD. Diminished physical activity and social contact might have hastened the deterioration of cognition and the worsening of NPS.Conclusion: Social isolation and physical inactivity even after strict lockdown for at least 6 months were correlated with accelerated decline of cognitive function and NPS in patients with AD and DLB.

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Neuropsychiatric profiles and conversion to dementia in mild cognitive impairment, a latent class analysis

Scientific Reports ◽

10.1038/s41598-021-83126-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Natalia Roberto ◽

Maria J. Portella ◽

Marta Marquié ◽

Montserrat Alegret ◽

Isabel Hernández ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Dementia With Lewy Bodies ◽

Latent Class ◽

Neuropsychiatric Symptoms ◽

Lewy Bodies ◽

Memory Clinic ◽

Risk Effect ◽

Anxiety Depression

AbstractNeuropsychiatric symptoms (NPS) have been recently addressed as risk factors of conversion to Alzheimer’s disease (AD) and other dementia types in patients diagnosed with Mild Cognitive Impairment (MCI). Our aim was to determine profiles based on the prominent NPS in MCI patients and to explore the predictive value of these profiles on conversion to specific types of dementia. A total of 2137 MCI patients monitored in a memory clinic were included in the study. Four NPS profiles emerged (classes), which were defined by preeminent symptoms: Irritability, Apathy, Anxiety/Depression and Asymptomatic. Irritability and Apathy were predictors of conversion to dementia (HR = 1.43 and 1.56, respectively). Anxiety/depression class showed no risk effect of conversion when compared to Asymptomatic class. Irritability class appeared as the most discriminant neuropsychiatric condition to identify non-AD converters (i.e., frontotemporal dementia, vascular dementia, Parkinson’s disease and dementia with Lewy Bodies). The findings revealed that consistent subgroups of MCI patients could be identified among comorbid basal NPS. The preeminent NPS showed to behave differentially on conversion to dementia, beyond AD. Therefore, NPS should be used as early diagnosis facilitators, and should also guide clinicians to detect patients with different illness trajectories in the progression of MCI.

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The Prevalence of Mild Cognitive Impairment among Chinese People: A Meta-Analysis

Neuroepidemiology ◽

10.1159/000512597 ◽

2021 ◽

Vol 55 (2) ◽

pp. 79-91

Author(s):

Yan Deng ◽

Siqi Zhao ◽

Guangwen Cheng ◽

Jiajia Yang ◽

Benchao Li ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Internal Validity ◽

Screening Tools ◽

Chinese Elderly ◽

Pooled Prevalence

Background: Mild cognitive impairment (MCI) induced the majority number of dementia patients. The prevalence of MCI in China varied across studies with different screening tools and diagnostic criteria. Objective: A systematic review and meta-analysis was conducted to estimate the pooled MCI prevalence among the population aged 55 years and older in China. Methods: PubMed, EMBASE, CNKI, Wanfang, CQVIP, and CBMdisc were searched for studies on prevalence of MCI among Chinese elderly between January 1, 1980, and February 10, 2020. The quality assessment was conducted via external validity, internal validity, and informativity, the pooled prevalence was calculated through the random-effect model, and the homogeneity was evaluated by Cochran’s Q test and I2. Results: Fifty-three studies with 123,766 subjects were included. The pooled prevalence of MCI among Chinese elderly was 15.4% (95% CI: 13.5–17.4%). Subgroup analyses indicated that the prevalence calculated with different screening tools was 20.2% (95% CI: 15.1–25.9%) for Montreal Cognitive Assessment (MoCA) and 13.0% (95% CI: 10.7–15.5%) for Mini-Mental State Examination (MMSE). According to different diagnostic criteria, the prevalence was 14.8% (95% CI: 12.2–17.6%) for Petersen criteria, 15.0% (95% CI: 12.7–17.5%) for DSM-IV, and 21.2% (95% CI: 17.5–25.2%) for Chinese Expert Consensus on Cognitive Impairment (CECCI). Besides, women, older adults, illiterate people, rural residents, and those who lived with unhealthy lifestyles and morbidity showed higher prevalence. Conclusions: The prevalence of MCI in China was 15.4%, which varied by demographics, lifestyles, morbidity, screening tools, and diagnostic criteria. In further studies, screening tools and diagnosis criteria should be considered when estimating MCI prevalence.

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In vivo nucleus basalis of Meynert degeneration in mild cognitive impairment with Lewy bodies

NeuroImage Clinical ◽

10.1016/j.nicl.2021.102604 ◽

2021 ◽

Vol 30 ◽

pp. 102604

Author(s):

Julia Schumacher ◽

John-Paul Taylor ◽

Calum A. Hamilton ◽

Michael Firbank ◽

Ruth A. Cromarty ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Lewy Bodies ◽

Nucleus Basalis ◽

Nucleus Basalis Of Meynert

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Characterization of dementia with Lewy bodies (DLB) and mild cognitive impairment using the Lewy body dementia module (LBD‐MOD)

Alzheimer s & Dementia ◽

10.1002/alz.12334 ◽

2021 ◽

Author(s):

James E. Galvin ◽

Stephanie Chrisphonte ◽

Iris Cohen ◽

Keri K. Greenfield ◽

Michael J. Kleiman ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Lewy Body ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Lewy Body Dementia

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A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

Neurology International ◽

10.4081/ni.2013.e16 ◽

2013 ◽

Vol 5 (3) ◽

pp. 16 ◽

Cited By ~ 4

Author(s):

Fábio Henrique De Gobbi Porto ◽

Lívia Spíndola ◽

Maira Okada De Oliveira ◽

Patrícia Helena Figuerêdo Do Vale ◽

Marco Orsini ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Characteristic Curve ◽

Neuropsychological Testing ◽

Area Under The Curve ◽

Screening Tests ◽

Elderly Subjects ◽

Subjective Memory ◽

Delayed Recall ◽

Memory Complaints

It is not easy to differentiate patients with mild cognitive impairment (MCI) from subjective memory complainers (SMC). Assessments with screening cognitive tools are essential, particularly in primary care where most patients are seen. The objective of this study was to evaluate the diagnostic accuracy of screening cognitive tests and to propose a score derived from screening tests. Elderly subjects with memory complaints were evaluated using the Mini Mental State Examination (MMSE) and the Brief Cognitive Battery (BCB). We added two delayed recalls in the MMSE (a delayed recall and a late-delayed recall, LDR), and also a phonemic fluency test of letter P fluency (LPF). A score was created based on these tests. The diagnoses were made on the basis of clinical consensus and neuropsychological testing. Receiver operating characteristic curve analyses were used to determine area under the curve (AUC), the sensitivity and specificity for each test separately and for the final proposed score. MMSE, LDR, LPF and delayed recall of BCB scores reach statistically significant differences between groups (P=0.000, 0.03, 0.001 and 0.01, respectively). Sensitivity, specificity and AUC were MMSE: 64%, 79% and 0.75 (cut off <29); LDR: 56%, 62% and 0.62 (cut off <3); LPF: 71%, 71% and 0.71 (cut off <14); delayed recall of BCB: 56%, 82% and 0.68 (cut off <9). The proposed score reached a sensitivity of 88% and 76% and specificity of 62% and 75% for cut off over 1 and over 2, respectively. AUC were 0.81. In conclusion, a score created from screening tests is capable of discriminating MCI from SMC with moderate to good accurancy.

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