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

Lookup NU author(s): Dr Paul Donaghy, Dr John-Paul Taylor, Professor John O'Brien, Nicola Barnett, Kirsty Olsen, Dr Sean Colloby, Dr James Lloyd, Dr George Petrides, Professor Ian McKeith, Professor Alan Thomas

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Cambridge University Press, 2018.

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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 FP-CIT SPECT. MCI-LB was diagnosed if two or more diagnostic features of DLB were present (visual hallucinations, cognitive fluctuations, motor parkinsonism, REM 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 dementia with Lewy bodies (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.


Publication metadata

Author(s): Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Colloby SJ, Lloyd J, Petrides G, McKeith IG, Thomas AJ

Publication type: Article

Publication status: Published

Journal: Psychological Medicine

Year: 2018

Volume: 48

Issue: 14

Pages: 2384-2390

Print publication date: 01/10/2018

Online publication date: 24/01/2018

Acceptance date: 20/12/2017

ISSN (print): 0033-2917

ISSN (electronic): 1469-8978

Publisher: Cambridge University Press

URL: https://doi.org/10.1017/S0033291717003956

DOI: 10.1017/S0033291717003956


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