TY - JOUR
T1 - Disease progression in dementia with Lewy bodies
T2 - A longitudinal study on clinical symptoms, quality of life and functional impairment
AU - van de Beek, Marleen
AU - van Unnik, Annemartijn
AU - van Steenoven, Inger
AU - van der Zande, Jessica
AU - Barkhof, Frederik
AU - Teunissen, Charlotte E.
AU - van der Flier, Wiesje
AU - Lemstra, Afina W.
N1 - Funding Information: Research of the Alzheimer Center Amsterdam is part of the Neurodegeneration research program of the Neuroscience Campus Amsterdam. The Alzheimer Center Amsterdam is supported by Alzheimer Nederland and Stichting VUMC funds. Afina W. Lemstra. has received funding from stichting Dioraphte and ZonMW Memorabel (project #733050509). Publisher Copyright: © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background and Objectives: Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL). Methods: We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow-up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL-AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL-AD). Results: Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change β ± SE = −2.06 ± 0.23), QoL-AD (−1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL-AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co-pathology (CSF pTau/Aβ42 ratio) was associated to steeper decline in MMSE (−1.23 ± 0.54). Medial temporal atrophy (−0.81 ± 0.26) and global cortical atrophy (−0.73 ± 0.36) predisposed for decline in QoL-AD. Conclusions: Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures.
AB - Background and Objectives: Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL). Methods: We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow-up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL-AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL-AD). Results: Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change β ± SE = −2.06 ± 0.23), QoL-AD (−1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL-AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co-pathology (CSF pTau/Aβ42 ratio) was associated to steeper decline in MMSE (−1.23 ± 0.54). Medial temporal atrophy (−0.81 ± 0.26) and global cortical atrophy (−0.73 ± 0.36) predisposed for decline in QoL-AD. Conclusions: Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures.
KW - IADL
KW - dementia with Lewy bodies
KW - progression
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=85142639592&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/gps.5839
DO - https://doi.org/10.1002/gps.5839
M3 - Article
C2 - 36403133
SN - 0885-6230
VL - 37
JO - International journal of geriatric psychiatry
JF - International journal of geriatric psychiatry
IS - 12
M1 - GPS5839
ER -