1
|
Wyman-Chick KA, Ferman TJ, Weintraub D, Armstrong MJ, Boeve BF, Bayram E, Chrenka E, Barrett MJ. Distinguishing Prodromal Dementia With Lewy Bodies From Prodromal Alzheimer Disease: A Longitudinal Study. Neurol Clin Pract 2025; 15:e200380. [PMID: 39399551 PMCID: PMC11464229 DOI: 10.1212/cpj.0000000000200380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/17/2024] [Indexed: 10/15/2024]
Abstract
Background and Objectives It can be clinically challenging to differentiate dementia with Lewy bodies (DLB) and Alzheimer disease (AD). As potential therapies emerge with the goal of slowing or halting misfolded protein aggregation, it is imperative to be able to identify individuals before the disease becomes disabling. Differentiating between DLB and AD in the preclinical or prodromal phase of DLB and AD becomes more important. Studies are needed to validate the proposed criteria for prodromal DLB. Methods Longitudinal data were obtained from the Uniform Data Set of the National Alzheimer's Coordinating Center. Included participants had a baseline diagnosis of normal or mild cognitive impairment and a consecutive 2-year follow-up diagnosis of DLB or AD. We examined whether core DLB clinical features, supportive neuropsychiatric features, and neuropsychological data in the 2 years preceding the dementia diagnosis distinguished DLB from AD. Results We identified 143 participants with DLB and 429 age-matched/sex-matched participants with AD. The presence of 2 or more core DLB features in the year before dementia diagnosis yielded the greatest AUC (0.793; 95% CI 0.748-0.839) in distinguishing prodromal DLB from prodromal AD. Sleep disturbances, hallucinations, and a cognitive profile of worse processing speed, attention, and visuoconstruction performance were evident at least 2 years before the dementia diagnosis in DLB compared with AD. Discussion Data from this multisite, longitudinal, well-characterized research North American cohort support the validity of the recently published criteria for prodromal DLB. In the prodromal stage, patients who subsequently develop DLB are more likely to have core DLB clinical features and worse attention, processing speed, and visuospatial performance than those who go on to develop AD. Differentiation of DLB and AD before dementia emerges provides an opportunity for early, disease-specific intervention and overall management.
Collapse
Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Tanis J Ferman
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Daniel Weintraub
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Melissa J Armstrong
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Bradley F Boeve
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Ece Bayram
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Ella Chrenka
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| | - Matthew J Barrett
- Struthers Parkinson's Center (KAW-C), Department of Neurology, HealthPartners/Park Nicollet, Golden Valley, MN; HealthPartners Institute (KAW-C, EC), Bloomington, MN; Department of Psychiatry and Psychology (TJF), Mayo Clinic, Jacksonville, FL; Departments of Psychiatry and Neurology (DW), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Parkinson's Disease Research (DW), Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, PA; Norman Fixel Institute for Neurologic Diseases (MJA), University of Florida; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Department of Neurology and Center for Sleep Medicine (BFB), Mayo Clinic, Rochester, NY; Department of Neurosciences (EB), University of California San Diego; and Department of Neurology (MJB), Virginia Commonwealth University, Richmond
| |
Collapse
|
2
|
Gibson LL, Mueller C, Stewart R, Aarsland D. Characteristics associated with progression to probable dementia with Lewy bodies in a cohort with very late-onset psychosis. Psychol Med 2024:1-10. [PMID: 39324394 DOI: 10.1017/s0033291724001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Very late-onset psychosis (VLOP) is associated with higher rates of dementia but the proportion who develop dementia with Lewy bodies (DLB) is unknown. We aimed to identify individuals with VLOP who develop dementia and DLB and characterize the risk factors for progression. METHODS Anonymized data were retrieved from electronic records for individuals with VLOP. Patients developing dementia after psychosis were identified, in addition to those with >2 core features of DLB at the time of dementia or DLB identified by a natural language processing application (NLP-DLB). Demographic factors, Health of the National Outcome Scale (HoNOS) and symptoms at index psychosis were explored as predictors of progression to dementia. RESULTS In 1425 patients with VLOP over 4.29 years (mean) follow up, 197 (13.8%) received a subsequent diagnosis of dementia. Of these, 24.4% (n = 48) had >2 core features of DLB and 6% (n = 12) had NLP-DLB. In cox proportional hazard models, older age and cognitive impairment at the time of psychosis were associated with increased risk of incident dementia. Visual hallucinations and 2+ core features of DLB at index psychosis were associated with increased risk of dementia with 2+ symptoms of DLB but not all-cause dementia. Two or more core features of DLB at index psychosis were associated with 81% specificity and 67% sensitivity for incident NLP-DLB. CONCLUSIONS In patients with VLOP who develop dementia, core features of DLB are common. Visual hallucinations or two core features of DLB in VLOP should prompt clinicians to consider DLB and support further investigation.
Collapse
Affiliation(s)
- Lucy L Gibson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dag Aarsland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
3
|
Devenyi RA, Hamedani AG. Visual dysfunction in dementia with Lewy bodies. Curr Neurol Neurosci Rep 2024; 24:273-284. [PMID: 38907811 PMCID: PMC11258179 DOI: 10.1007/s11910-024-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW To review the literature on visual dysfunction in dementia with Lewy bodies (DLB), including its mechanisms and clinical implications. RECENT FINDINGS Recent studies have explored novel aspects of visual dysfunction in DLB, including visual texture agnosia, mental rotation of 3-dimensional drawn objects, and reading fragmented letters. Recent studies have shown parietal and occipital hypoperfusion correlating with impaired visuoconstruction performance. While visual dysfunction in clinically manifest DLB is well recognized, recent work has focused on prodromal or mild cognitive impairment (MCI) due to Lewy body pathology with mixed results. Advances in retinal imaging have recently led to the identification of abnormalities such as parafoveal thinning in DLB. Patients with DLB experience impairment in color perception, form and object identification, space and motion perception, visuoconstruction tasks, and illusions in association with visual cortex and network dysfunction. These symptoms are associated with visual hallucinations, driving impairment, falls, and other negative outcomes.
Collapse
Affiliation(s)
- Ryan A Devenyi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
4
|
Hamilton CA, Donaghy PC, Durcan R, Ciafone J, Olsen K, Roberts G, Firbank MJ, Allan LM, Taylor JP, O'Brien JT, Thomas AJ. Outcomes of Patients With Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease at 3 and 5 Years After Diagnosis. Neurology 2024; 103:e209499. [PMID: 38870460 PMCID: PMC11244743 DOI: 10.1212/wnl.0000000000209499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/26/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES 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. DISCUSSION 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.
Collapse
Affiliation(s)
- Calum A Hamilton
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Rory Durcan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Kirsty Olsen
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Gemma Roberts
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Louise M Allan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - John T O'Brien
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., R.D., J.C., K.O., G.R., M.J.F., J.-P.T., A.J.T.), Newcastle University; Centre for Research in Ageing and Cognitive Health (L.M.A.), University of Exeter; and Department of Psychiatry (J.T.O.B.), School of Clinical Medicine, University of Cambridge, United Kingdom
| |
Collapse
|
5
|
Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024; 13:885-906. [PMID: 38720013 PMCID: PMC11136939 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
Collapse
Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| |
Collapse
|
6
|
Hamilton CA, Gallagher P, Ciafone J, Barnett N, Barker SAH, Donaghy PC, O'Brien JT, Taylor JP, Thomas AJ. Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:421-427. [PMID: 38017617 DOI: 10.1017/s1355617723000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer's disease (MCI-AD), and any performance deficits which emerged with sustained effort. METHOD We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). RESULTS While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1-4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3-2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2-8.8). CONCLUSIONS Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sally A H Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
Fernando R, Thomas AJ, Hamilton CA, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan LM, McKeith IG, O'Brien JT, Taylor JP, Donaghy PC. Identifying parkinsonism in mild cognitive impairment. J Neurol Sci 2024; 458:122941. [PMID: 38422782 DOI: 10.1016/j.jns.2024.122941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson's Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. METHODS Participants with MCI from two cohorts (n = 146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. RESULTS The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. CONCLUSIONS The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.
Collapse
Affiliation(s)
- Rishira Fernando
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sean Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
| |
Collapse
|
8
|
Zhu CW, Grossman HT, Elder GA, Rosen H, Sano M. Apathy in Lewy body disease and its effects on functional impairment over time. Front Neurol 2024; 15:1339190. [PMID: 38313558 PMCID: PMC10835801 DOI: 10.3389/fneur.2024.1339190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background and objectives Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Methods Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Results Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. Discussion In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.
Collapse
Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hillel T. Grossman
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A. Elder
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mary Sano
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
9
|
Satake Y, Kanemoto H, Taomoto D, Suehiro T, Koizumi F, Sato S, Wada T, Matsunaga K, Shimosegawa E, Gotoh S, Mori K, Morihara T, Yoshiyama K, Ikeda M. Characteristics of very late-onset schizophrenia-like psychosis classified with the biomarkers for Alzheimer's disease: a retrospective cross-sectional study. Int Psychogeriatr 2024; 36:64-77. [PMID: 36714996 DOI: 10.1017/s1041610222001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We aimed to investigate the association between very late-onset schizophrenia-like psychosis (VLOSLP), a schizophrenia spectrum disorder with an onset of ≥60 years, and Alzheimer's disease (AD) using biomarkers. DESIGN Retrospective cross-sectional study. SETTING Neuropsychology clinic of Osaka University Hospital in Japan. PARTICIPANTS Thirty-three participants were classified into three groups: eight AD biomarker-negative VLOSLP (VLOSLP-AD), nine AD biomarker-positive VLOSLP (VLOSLP+AD), and sixteen amnestic mild cognitive impairment due to AD without psychosis (aMCI-P+AD) participants. MEASUREMENTS Phosphorylated tau levels in the cerebrospinal fluid and 18F-Florbetapir positron emission tomography results were used as AD biomarkers. Several scales (e.g. the Mini-Mental State Examination (MMSE), Wechsler Memory Scale-Revised (WMS-R) Logical Memory (LM) I and II, and Neuropsychiatric Inventory (NPI)-plus) were conducted to assess clinical characteristics. RESULTS Those in both VLOSLP-AD and +AD groups scored higher than those in aMCI-P+AD in WMS-R LM I. On the other hand, VLOSLP+AD participants scored in between the other two groups in the WMS-R LM II, with only VLOSLP-AD participants scoring significantly higher than aMCI-P+AD participants. There were no significant differences in sex distribution and MMSE scores among the three groups or in the subtype of psychotic symptoms between VLOSLP-AD and +AD participants. Four VLOSLP-AD and five VLOSLP+AD participants harbored partition delusions. Delusion of theft was shown in two VLOSLP-AD patients and five VLOSLP+AD patients. CONCLUSION Some VLOSLP patients had AD pathology. Clinical characteristics were different between AD biomarker-positive and AD biomarker-negative VLOSLP, which may be helpful for detecting AD pathology in VLOSLP patients.
Collapse
Affiliation(s)
- Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fuyuki Koizumi
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shiho Gotoh
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kohji Mori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Morihara
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Psychiatry, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
10
|
Hamilton CA, O'Brien J, Heslegrave A, Laban R, Donaghy P, Durcan R, Lawley S, Barnett N, Roberts G, Firbank M, Taylor JP, Zetterberg H, Thomas A. Plasma biomarkers of neurodegeneration in mild cognitive impairment with Lewy bodies. Psychol Med 2023; 53:7865-7873. [PMID: 37489795 PMCID: PMC10755229 DOI: 10.1017/s0033291723001952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/17/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Blood biomarkers of Alzheimer's disease (AD) may allow for the early detection of AD pathology in mild cognitive impairment (MCI) due to AD (MCI-AD) and as a co-pathology in MCI with Lewy bodies (MCI-LB). However not all cases of MCI-LB will feature AD pathology. Disease-general biomarkers of neurodegeneration, such as glial fibrillary acidic protein (GFAP) or neurofilament light (NfL), may therefore provide a useful supplement to AD biomarkers. We aimed to compare the relative utility of plasma Aβ42/40, p-tau181, GFAP and NfL in differentiating MCI-AD and MCI-LB from cognitively healthy older adults, and from one another. METHODS Plasma samples were analysed for 172 participants (31 healthy controls, 48 MCI-AD, 28 possible MCI-LB and 65 probable MCI-LB) at baseline, and a subset (n = 55) who provided repeated samples after ≥1 year. Samples were analysed with a Simoa 4-plex assay for Aβ42, Aβ40, GFAP and NfL, and incorporated previously-collected p-tau181 from this same cohort. RESULTS Probable MCI-LB had elevated GFAP (p < 0.001) and NfL (p = 0.012) relative to controls, but not significantly lower Aβ42/40 (p = 0.06). GFAP and p-tau181 were higher in MCI-AD than MCI-LB. GFAP discriminated all MCI subgroups, from controls (AUC of 0.75), but no plasma-based marker effectively differentiated MCI-AD from MCI-LB. NfL correlated with disease severity and increased with MCI progression over time (p = 0.011). CONCLUSION Markers of AD and astrocytosis/neurodegeneration are elevated in MCI-LB. GFAP offered similar utility to p-tau181 in distinguishing MCI overall, and its subgroups, from healthy controls.
Collapse
Affiliation(s)
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute, London, UK
- Department of Neurodegenerative Disease, University College London, London, UK
| | | | - Paul Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute, London, UK
- Department of Neurodegenerative Disease, University College London, London, UK
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| |
Collapse
|
11
|
Donaghy PC, Carrarini C, Ferreira D, Habich A, Aarsland D, Babiloni C, Bayram E, Kane JP, Lewis SJ, Pilotto A, Thomas AJ, Bonanni L. Research diagnostic criteria for mild cognitive impairment with Lewy bodies: A systematic review and meta-analysis. Alzheimers Dement 2023; 19:3186-3202. [PMID: 37096339 PMCID: PMC10695683 DOI: 10.1002/alz.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Operationalized research criteria for mild cognitive impairment with Lewy bodies (MCI-LB) were published in 2020. The aim of this systematic review and meta-analysis was to review the evidence for the diagnostic clinical features and biomarkers in MCI-LB set out in the criteria. METHODS MEDLINE, PubMed, and Embase were searched on 9/28/22 for relevant articles. Articles were included if they presented original data reporting the rates of diagnostic features in MCI-LB. RESULTS Fifty-seven articles were included. The meta-analysis supported the inclusion of the current clinical features in the diagnostic criteria. Evidence for striatal dopaminergic imaging and meta-iodobenzylguanidine cardiac scintigraphy, though limited, supports their inclusion. Quantitative electroencephalogram (EEG) and fluorodeoxyglucose positron emission tomography (PET) show promise as diagnostic biomarkers. DISCUSSION The available evidence largely supports the current diagnostic criteria for MCI-LB. Further evidence will help refine the diagnostic criteria and understand how best to apply them in clinical practice and research. HIGHLIGHTS A meta-analysis of the diagnostic features of MCI-LB was carried out. The four core clinical features were more common in MCI-LB than MCI-AD/stable MCI. Neuropsychiatric and autonomic features were also more common in MCI-LB. More evidence is needed for the proposed biomarkers. FDG-PET and quantitative EEG show promise as diagnostic biomarkers in MCI-LB.
Collapse
Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claudia Carrarini
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
- Hospital San Raffaele of Cassino, Cassino, Italy
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, California, USA
| | - Joseph Pm Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Simon Jg Lewis
- Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, Australia
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
12
|
Donaghy PC, Hamilton C, Durcan R, Lawley S, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Allan LM, Saha R, McKeith IG, O'Brien JT, Taylor J, Thomas AJ. Clinical symptoms in mild cognitive impairment with Lewy bodies: Frequency, time of onset, and discriminant ability. Eur J Neurol 2023; 30:1585-1593. [PMID: 36912421 PMCID: PMC10946617 DOI: 10.1111/ene.15783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment with Lewy bodies (MCI-LB) is associated with a range of cognitive, motor, neuropsychiatric, sleep, autonomic, and visual symptoms. We investigated the cumulative frequency of symptoms in a longitudinal cohort of MCI-LB compared with MCI due to Alzheimer disease (MCI-AD) and analysed the ability of a previously described 10-point symptom scale to differentiate MCI-LB and MCI-AD, in an independent cohort. METHODS Participants with probable MCI-LB (n = 70), MCI-AD (n = 51), and controls (n = 34) had a detailed clinical assessment and annual follow-up (mean duration = 1.7 years). The presence of a range of symptoms was ascertained using a modified version of the Lewy Body Disease Association Comprehensive LBD Symptom Checklist at baseline assessment and then annually. RESULTS MCI-LB participants experienced a greater mean number of symptoms (24.2, SD = 7.6) compared with MCI-AD (11.3, SD = 7.4) and controls (4.2, SD = 3.1; p < 0.001 for all comparisons). A range of cognitive, parkinsonian, neuropsychiatric, sleep, and autonomic symptoms were significantly more common in MCI-LB than MCI-AD, although when present, the time of onset was similar between the two groups. A previously defined 10-point symptom scale demonstrated very good discrimination between MCI-LB and MCI-AD (area under the receiver operating characteristic curve = 0.91, 95% confidence interval = 0.84-0.98), replicating our previous finding in a new cohort. CONCLUSIONS MCI-LB is associated with the frequent presence of a particular profile of symptoms compared to MCI-AD. Clinicians should look for evidence of these symptoms in MCI and be aware of the potential for treatment. The presence of these symptoms may help to discriminate MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Calum Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Sally Barker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Joanna Ciafone
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Kirsty Olsen
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- Nuclear Medicine DepartmentNewcastle Upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Jim Lloyd
- Nuclear Medicine DepartmentNewcastle Upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Louise M. Allan
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Ranjan Saha
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Ian G. McKeith
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - John T. O'Brien
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| |
Collapse
|
13
|
Gan J, Chen Z, Shi Z, Li X, Liu S, Liu Y, Zhu H, Shen L, Zhang G, You Y, Guo Q, Zhang N, Lv Y, Gang B, Yuan J, Ji Y. Sex differences in clinical cognitive impairment with Lewy bodies: a Chinese multicenter study. Biol Sex Differ 2022; 13:55. [PMID: 36183142 PMCID: PMC9526942 DOI: 10.1186/s13293-022-00464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background Research on sex ratios of Lewy body dementia is controversial, established in small samples, and rarely focused on prodromal stage. The objective is to investigate the clinical sex ratios (men/women) and their associations with clinical features among individuals with mild cognitive impairment with Lewy bodies (MCI-LB), dementia with Lewy bodies (DLB), Parkinson’s disease with mild cognitive impairment (PD-MCI), and Parkinson’s disease with dementia (PDD) in China. Methods We conducted a multicenter cohort study, including 1038 individuals with probable MCI-LB, DLB, PD-MCI, or PDD diagnosis from 22 memory clinics in China from January 2018 to March 2022, and recorded their demographic and clinical data by reviewing medical records. Descriptive and regression analyses were used to calculate the sex ratio (men/women), and its associations with demographic and clinical data. Results In this study, men comprised 35.14% (men/women sex ratio = 0.54) for MCI-LB, 46.72% (men/women sex ratio = 0.88) for DLB, 63.56% (men/women sex ratio = 1.74) for PD-MCI, and 52.40% (men/women sex ratio = 1.10) for PDD. Sex ratios roughly increased with age. Men had more parkinsonism (p = 0.000) and less fluctuating cognition (p = 0.024) in MCI-LB, and those with PD-MCI had more RBD (p = 0.001). Women with PD-MCI had lower MMSE scores (β ± standard error = − 1.24 ± 0.58, p = 0.04), more irritability (0.95 ± 0.46, p = 0.04) and fluctuating cognition (− 3.41 ± 1.31, p = 0.01), and less parkinsonism (− 2.10 ± 0.97, p = 0.03) than men after adjusting for demographic and cardiometabolic conditions. Conclusion There were more women in DLB and MCI-LB, and more men in PD-MCI and PDD. The sex distribution, demographic, and clinical characteristics differed, which strengthened the independence and heterogeneity of the four diseases, and indicated sex-sensitive strategies for management of dementia necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-022-00464-w. There are significant sex differences in Chinese population with cognitive impairment in Lewy body disease. Women were more common in dementia with Lewy bodies and mild cognitive impairment with Lewy bodies cases, had more frequent and severe neuropsychiatric symptoms, and poorer cognition than men. Men predominant in Parkinson’s disease with mild cognitive impairment and Parkinson’s disease with dementia cases, and performed more frequent RBD and parkinsonism than women. Dementia with Lewy bodies vs. Parkinson’s disease with dementia, and mild cognitive impairment with Lewy bodies vs. Parkinson’s disease with mild cognitive impairment are distinct disease forms and should not be confused.
Collapse
Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Zhichao Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China
| | - Xudong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Shandong, China
| | - Hongcan Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, China
| | - Guili Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Lv
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Baozhi Gang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junliang Yuan
- Department of Neurology, Peking University Sixth Hospital, Beijing, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China. .,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China.
| |
Collapse
|
14
|
Neuropsychological Impairments and Their Cognitive Architecture in Mild Cognitive Impairment (MCI) with Lewy Bodies and MCI-Alzheimer's Disease. J Int Neuropsychol Soc 2022; 28:963-973. [PMID: 34666864 DOI: 10.1017/s1355617721001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed). METHOD Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer's disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer's Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall. RESULTS MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05). CONCLUSIONS MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
Collapse
|
15
|
Donaghy PC, Cockell SJ, Martin-Ruiz C, Coxhead J, Kane J, Erskine D, Koss D, Taylor JP, Morris CM, O'Brien JT, Thomas AJ. Blood mRNA Expression in Alzheimer's Disease and Dementia With Lewy Bodies. Am J Geriatr Psychiatry 2022; 30:964-975. [PMID: 35283023 DOI: 10.1016/j.jagp.2022.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the expression of genes in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), both at the mild cognitive impairment (MCI) and dementia stages, to improve our understanding of disease pathophysiology and investigate the potential for diagnostic and prognostic biomarkers based on mRNA expression. DESIGN Cross-sectional observational study. SETTING University research center. PARTICIPANTS People with MCI with Lewy bodies (MCI-LB, n=55), MCI-AD (n=19), DLB (n=38), AD (n=24) and a cognitively unimpaired comparison group (n=28). MEASUREMENTS Ribonucleic acid sequencing of whole blood. Differentially expressed genes (DEGs) were identified and gene set enrichment analysis was carried out. RESULTS Compared with the cognitively unimpaired group, there were 22 DEGs in MCI-LB/DLB and 61 DEGs in MCI-AD/AD. DEGS were also identified when comparing the two disease groups. Expression of ANP32A was associated with more rapid cognitive decline in MCI-AD/AD. Gene set enrichment analysis identified downregulation in gene sets including MYC targets and oxidative phosphorylation in MCI-LB/DLB; upregulation of immune and inflammatory responses in MCI-AD/AD; and upregulation of interferon-α and -γ responses in MCI-AD/AD compared with MCI-LB/DLB. CONCLUSION This study identified multiple DEGs in MCI-LB/DLB and MCI-AD/AD. One of these DEGs, ANP32A, may be a prognostic marker in AD. Genes related to mitochondrial function were downregulated in MCI-LB/DLB. Previously reported upregulation of genes associated with inflammation and immune responses in MCI-AD/AD was confirmed in this cohort. Differences in interferon responses between MCI-AD/AD and MCI-LB/DLB suggest that there are key differences in peripheral immune responses between these diseases.
Collapse
Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Simon J Cockell
- School of Biomedical, Nutrition and Sports Sciences (SJC), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carmen Martin-Ruiz
- Biosciences Institute (CMR, JC), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Coxhead
- Biosciences Institute (CMR, JC), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Joseph Kane
- Centre for Public Health (JK), Queen's University Belfast, Belfast, United Kingdom
| | - Daniel Erskine
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Koss
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher M Morris
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry (JTO), University of Cambridge, Cambridge, United Kingdom
| | - Alan J Thomas
- Translational and Clinical Research Institute (PCD, DE, DK, JPT, CMM, AJT), Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
16
|
Abstract
OBJECTIVES Impaired olfaction may be a biomarker for early Lewy body disease, but its value in mild cognitive impairment with Lewy bodies (MCI-LB) is unknown. We compared olfaction in MCI-LB with MCI due to Alzheimer's disease (MCI-AD) and healthy older adults. We hypothesized that olfactory function would be worse in probable MCI-LB than in both MCI-AD and healthy comparison subjects (HC). DESIGN Cross-sectional study assessing olfaction using Sniffin' Sticks 16 (SS-16) in MCI-LB, MCI-AD, and HC with longitudinal follow-up. Differences were adjusted for age, and receiver operating characteristic (ROC) curves were used for discriminating MCI-LB from MCI-AD and HC. SETTING Participants were recruited from Memory Services in the North East of England. PARTICIPANTS Thirty-eight probable MCI-LB, 33 MCI-AD, 19 possible MCI-LB, and 32HC. MEASUREMENTS Olfaction was assessed using SS-16 and a questionnaire. RESULTS Participants with probable MCI-LB had worse olfaction than both MCI-AD (age-adjusted mean difference (B) = 2.05, 95% CI: 0.62-3.49, p = 0.005) and HC (B = 3.96, 95% CI: 2.51-5.40, p < 0.001). The previously identified cutoff score for the SS-16 of ≤ 10 had 84% sensitivity for probable MCI-LB (95% CI: 69-94%), but 30% specificity versus MCI-AD. ROC analysis found a lower cutoff of ≤ 7 was better (63% sensitivity for MCI-LB, with 73% specificity vs MCI-AD and 97% vs HC). Asking about olfactory impairments was not useful in identifying them. CONCLUSIONS MCI-LB had worse olfaction than MCI-AD and normal aging. A lower cutoff score of ≤ 7 is required when using SS-16 in such patients. Olfactory testing may have value in identifying early LB disease in memory services.
Collapse
|
17
|
Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5709. [PMID: 35388536 PMCID: PMC9321690 DOI: 10.1002/gps.5709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Orthostatic hypotension is a common feature of normal ageing, and age-related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease. We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI-LB) than MCI due to Alzheimer's disease (MCI-AD). METHODS MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI-LB, possible MCI-LB, or MCI-AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat-to-beat cardiovascular data, with abnormalities defined by current criteria, and age-adjusted group differences estimated with logistic models. RESULTS Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI-LB than MCI-AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI-LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI-LB than MCI-AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10-s after release of Valsalva strain were weakly correlated with cardiac sympathetic denervation. CONCLUSIONS Probable MCI-LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI-AD.
Collapse
Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Louise M. Allan
- College of Medicine and Health, St Luke's CampusExeter UniversityExeterUK
| | - John O’Brien
- Department of PsychiatryUniversity of Cambridge, Level E4, Addenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
18
|
Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5703. [PMID: 35302677 PMCID: PMC9311677 DOI: 10.1002/gps.5703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI-LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI-AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI-LB from MCI-AD. METHODS Ninety-three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31-item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI-AD or MCI-LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub-scales were assessed, controlling for age. RESULTS Age-adjusted severity of overall autonomic symptomatology was greater in MCI-LB (Ratio = 2.01, 95% CI: 1.37-2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI-AD did not have significantly higher autonomic symptom severity than controls overall. A cut-off of 4/5 on the COMPASS was sensitive to MCI-LB (92%) but not specific to this (42% specificity vs. MCI-AD and 52% vs. healthy controls). CONCLUSIONS Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI-AD, but such autonomic symptoms are not a specific finding. The COMPASS-31 may therefore have value as a sensitive screening test for early-stage Lewy body disease.
Collapse
Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - John O’Brien
- Department of PsychiatryUniversity of CambridgeAddenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
19
|
Thomas AJ, Hamilton CA, Heslegrave A, Barker S, Durcan R, Lawley S, Barnett N, Lett D, Firbank M, Roberts G, Taylor JP, Donaghy PC, Zetterberg H, O'Brien J. A Longitudinal Study of Plasma pTau181 in Mild Cognitive Impairment with Lewy Bodies and Alzheimer's Disease. Mov Disord 2022; 37:1495-1504. [PMID: 35318733 PMCID: PMC9540809 DOI: 10.1002/mds.28994] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) co-pathology is common in dementia with Lewy bodies and is associated with increased decline. Plasma pTau181 is a blood-based biomarker that can detect AD co-pathology. OBJECTIVES We investigated whether pTau181 was associated with cognitive decline in mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with AD (MCI-AD). METHODS We assessed plasma pTau181 using a single-molecule array (Simoa) immunoassay at baseline and follow-up in a longitudinal cohort of MCI-LB, MCI-AD, and controls. RESULTS One hundred forty-six subjects (56 probable MCI-LB, 22 possible MCI-LB, 44 MCI-AD, and 24 controls) were reviewed for up to 5.7 years. Probable MCI-LB had significantly higher pTau181 (22.2% mean increase) compared with controls and significantly lower (24.4% mean decrease) levels compared with MCI-AD. Receiver operating characteristic analyses of pTau181 in discriminating probable MCI-LB from controls showed an area under the curve (AUC) of 0.68 (83% specificity, 57% sensitivity); for discriminating MCI-AD from healthy controls, AUC was 0.8 (83.3% specificity, 72.7% sensitivity). pTau181 concentration was less useful in discriminating between probable MCI-LB and MCI-AD: AUC of 0.64 (71.4% specificity, 52.3% sensitivity). There was an association between pTau181 and cognitive decline in MCI-AD but not in MCI-LB. In a subset with repeat samples there was a nonsignificant 3% increase per follow-up year in plasma pTau181. The rate of change in pTau181 was not significantly different in different diagnostic subgroups. CONCLUSIONS pTau181 was not associated with an increased decline assessed using either baseline or repeat pTau181. pTau181 partially discriminated probable MCI-LB from controls and MCI-AD from controls but was not useful in distinguishing probable MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Debbie Lett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| |
Collapse
|
20
|
Di Vita A, Vecchione F, Boccia M, Bocchi A, Cinelli MC, Mirino P, Teghil A, D'Antonio F, de Lena C, Piccardi L, Giannini AM, Guariglia C. DiaNe: A New First Level Computerized Tool Assessing Memory, Attention, and Visuospatial Processing to Detect Early Pathological Cognitive Decline. J Alzheimers Dis 2022; 86:891-904. [PMID: 35147537 DOI: 10.3233/jad-215294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Detecting the beginning of cognitive decay is crucial to guarantee good management and the possible prevention of dementia progression. The present study arises from observations collected during an educational event to promote mental and physical health in which incidental neuropsychological data gathered on 290 citizens showed the importance of routine neuropsychological examination in detecting early signs of cognitive decay, since many individuals were unaware of the decrease in their cognitive efficiency. Accordingly, the availability of a screening tool that is computerized, portable, self-administrable, and sensitive to the main neurocognitive changes testifying the progression towards pathological aging is critical. OBJECTIVE To this aim, we developed a computerized battery for the early, preclinical Diagnosis of Neurocognitive disease (DiaNe), that can be self-administered and performed autonomously by using a tablet. METHODS DiaNe includes tests expected to evaluate the main cognitive domains involved in neurodegenerative diseases (memory, attention, executive functions) with a detailed assessment of visuospatial memory in particular. RESULTS DiaNe is not just the translation of standard tests into telematics, rather it is a new tool that provides both accuracy and response time measurements, aimed to screen cognitive profile and monitor it over time, being able to detect changes in still normal performances that may be suggestive of an ongoing onset of neurocognitive disorders. CONCLUSION Here we present an investigation of DiaNe concurrent validity showing that its results are comparable to those obtained by existing paper-and-pencil neuropsychological tests, and propose that DiaNe could be a useful, quick, and economical instrument for the monitoring of cognitive aging.
Collapse
Affiliation(s)
- Antonella Di Vita
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Vecchione
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| | - Maddalena Boccia
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| | - Alessia Bocchi
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Cristina Cinelli
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| | - Pierandrea Mirino
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy.,PhD Program in Behavioral Neuroscience, "Sapienza" University of Rome, Rome, Italy
| | - Alice Teghil
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| | - Fabrizia D'Antonio
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Laura Piccardi
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| | | | - Cecilia Guariglia
- Department of Psychology, "Sapienza" University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Rome, Italy
| |
Collapse
|
21
|
Hamilton CA, Schumacher J, Matthews F, Taylor JP, Allan L, Barnett N, Cromarty RA, Donaghy PC, Durcan R, Firbank M, Lawley S, O'Brien JT, Roberts G, Thomas AJ. Slowing on quantitative EEG is associated with transition to dementia in mild cognitive impairment. Int Psychogeriatr 2021; 33:1321-1325. [PMID: 34551831 DOI: 10.1017/s1041610221001083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer's disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01-3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Schumacher
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, Herschel Smith Building, University of Cambridge, Cambridge, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
22
|
Stacy KE, Perazzo J, Shatz R, Bakas T. Needs and Concerns of Lewy Body Disease Family Caregivers: A Qualitative Study. West J Nurs Res 2021; 44:227-238. [PMID: 34636259 DOI: 10.1177/01939459211050957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lewy body disease (LBD) is a devastating condition with cognitive and physical deficits that pose a challenge to family caregivers. The purpose of this study was to identify the needs and concerns of family caregivers of persons with LBD. A convenience sample of LBD caregivers were interviewed regarding their caregiving needs, concerns, strategies, and advice. A content analysis approach was used to organize data into themes from an existing needs and concerns framework. Findings included the need for more information about the disease, strategies for managing LBD-related emotions and behaviors, support and assistance with physical and instrumental care, and strategies for managing one's own personal responses to caregiving. Findings highlight the need for a Lewy body specific caregiver assessment tool and future caregiver interventions.
Collapse
Affiliation(s)
- Kelly E Stacy
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph Perazzo
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation, University of Cincinnati, Cincinnati, OH, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
23
|
Hamilton CA, Matthews FE, Allan LM, Barker S, Ciafone J, Donaghy PC, Durcan R, Firbank MJ, Lawley S, O'Brien JT, Roberts G, Taylor JP, Thomas AJ. Utility of the pareidolia test in mild cognitive impairment with Lewy bodies and Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:1407-1414. [PMID: 33772864 DOI: 10.1002/gps.5546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Previous research has identified that dementia with Lewy bodies (DLB) has abnormal pareidolic responses which are associated with severity of visual hallucinations (VH), and the pareidolia test accurately classifies DLB with VH. We aimed to assess whether these findings would also be evident at the earlier stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) in comparison to MCI due to AD (MCI-AD) and cognitively healthy comparators. METHODS One-hundred and thirty-seven subjects were assessed prospectively in a longitudinal study with a mean follow-up of 1.2 years (max = 3.7): 63 MCI-LB (22% with VH) and 40 MCI-AD according to current research diagnostic criteria, and 34 healthy comparators. The pareidolia test was administered annually as a repeated measure. RESULTS Probable MCI-LB had an estimated pareidolia rate 1.2-6.7 times higher than MCI-AD. Pareidolia rates were not associated with concurrent VH, but had a weak association with total score on the North East Visual Hallucinations Inventory. The pareidolia test was not an accurate classifier of either MCI-LB (Area under curve (AUC) = 0.61), or VH (AUC = 0.56). There was poor sensitivity when differentiating MCI-LB from controls (41%) or MCI-AD (27%), though specificity was better (91% and 89%, respectively). CONCLUSIONS Whilst pareidolic responses are specifically more frequent in MCI-LB than MCI-AD, sensitivity of the pareidolia test is poorer than in DLB, with fewer patients manifesting VH at the earlier MCI stage. However, the high specificity and ease of use may make it useful in specialist clinics where imaging biomarkers are not available.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
24
|
Schumacher J, Taylor JP, Hamilton CA, Firbank M, Donaghy PC, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Functional connectivity in mild cognitive impairment with Lewy bodies. J Neurol 2021; 268:4707-4720. [PMID: 33928432 PMCID: PMC8563567 DOI: 10.1007/s00415-021-10580-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022]
Abstract
Previous resting-state fMRI studies in dementia with Lewy bodies have described changes in functional connectivity in networks related to cognition, motor function, and attention as well as alterations in connectivity dynamics. However, whether these changes occur early in the course of the disease and are already evident at the stage of mild cognitive impairment is not clear. We studied resting-state fMRI data from 31 patients with mild cognitive impairment with Lewy bodies compared to 28 patients with mild cognitive impairment due to Alzheimer’s disease and 24 age-matched controls. We compared the groups with respect to within- and between-network functional connectivity. Additionally, we applied two different approaches to study dynamic functional connectivity (sliding-window analysis and leading eigenvector dynamic analysis). We did not find any significant changes in the mild cognitive impairment groups compared to controls and no differences between the two mild cognitive impairment groups, using static as well as dynamic connectivity measures. While patients with mild cognitive impairment with Lewy bodies already show clear functional abnormalities on EEG measures, the fMRI analyses presented here do not appear to be sensitive enough to detect such early and subtle changes in brain function in these patients.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
25
|
Roberts G, Durcan R, Donaghy PC, Lawley S, Ciafone J, Hamilton CA, Colloby SJ, Firbank MJ, Allan L, Barnett N, Barker S, Howe K, Ali T, Petrides GS, Lloyd J, Taylor JP, O'Brien J, Thomas AJ. Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies. Neurology 2021; 96:e2801-e2811. [PMID: 33883238 PMCID: PMC8205462 DOI: 10.1212/wnl.0000000000012060] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To provide evidence that cardiac I-123-metaiodobenzylguanidine sympathetic innervation imaging (MIBG) scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer 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. Methods We 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. Results We 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 cases. The sensitivity in probable MCI-LB was 59% (95% confidence interval [CI], 42%–75%), specificity 88% (75%–96%), and accuracy 75% (64%–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%–87%) and 76% for FP-CIT (95% CI, 65%–85%). Conclusions Cardiac MIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicenter setting is justified. Classification of Evidence This study provides Class I evidence that cardiac MIBG distinguishes MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Gemma Roberts
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Rory Durcan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sarah Lawley
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Calum A Hamilton
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sean J Colloby
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Louise Allan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally Barker
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kim Howe
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Tamir Ali
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - George S Petrides
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Jim Lloyd
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John O'Brien
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| |
Collapse
|
26
|
Firbank MJ, Durcan R, O'Brien JT, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Roberts G, Taylor JP, Thomas AJ. Hippocampal and insula volume in mild cognitive impairment with Lewy bodies. Parkinsonism Relat Disord 2021; 86:27-33. [PMID: 33823470 DOI: 10.1016/j.parkreldis.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diagnostic criteria for prodromal dementia with Lewy bodies have recently been published. These include the use of imaging biomarkers to distinguish mild cognitive impairment with Lewy bodies (MCI-LB) from MCI due to other causes. Two potential biomarkers listed, though not formally included in the diagnostic criteria, due to insufficient evidence, are relatively preserved hippocampi, and atrophy of the insula cortex on structural brain imaging. METHODS In this report, we sought to investigate these imaging biomarkers in 105 research subjects, including well characterised groups of patients with MCI-LB (n = 38), MCI with no core features of Lewy body disease (MCI-AD; n = 36) and healthy controls (N = 31). Hippocampal and insula volumes were determined from T1 weighted structural MRI scans, using grey matter segmentation performed with SPM software. RESULTS Adjusting for age, sex and intracranial volume, there were no differences in hippocampal or insula volume between MCI-AD and MCI-LB, although in both conditions volumes were significantly reduced relative to controls. CONCLUSION Our results do not support the use of either hippocampal or insula volume to identify prodromal dementia with Lewy bodies.
Collapse
Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | | | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| |
Collapse
|
27
|
Characterization of symptoms and determinants of disease burden in dementia with Lewy bodies: DEvELOP design and baseline results. ALZHEIMERS RESEARCH & THERAPY 2021; 13:53. [PMID: 33637117 PMCID: PMC7908769 DOI: 10.1186/s13195-021-00792-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/16/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The DEmEntia with LEwy bOdies Project (DEvELOP) aims to phenotype patients with dementia with Lewy bodies (DLB) and study the symptoms and biomarkers over time. Here, we describe the design and baseline results of DEvELOP. We investigated the associations between core and suggestive DLB symptoms and different aspects of disease burden, i.e., instrumental activities of daily living (IADL) functioning, quality of life (QoL), and caregiver burden. METHODS We included 100 DLB patients (69 ± 6 years, 10%F, MMSE 25 ± 3) in the prospective DEvELOP cohort. Patients underwent extensive assessment including MRI, EEG/MEG, 123FP-CIT SPECT, and CSF and blood collection, with annual follow-up. Core (hallucinations, parkinsonism, fluctuations, RBD) and suggestive (autonomous dysfunction, neuropsychiatric symptoms) symptoms were assessed using standardized questionnaires. We used multivariate regression analyses, adjusted for age, sex, and MMSE, to evaluate how symptoms related to the Functional Activities Questionnaire, QoL-AD questionnaire, and Zarit Caregiver Burden Interview. RESULTS In our cohort, RBD was the most frequently reported core feature (75%), while visual hallucinations were least frequently reported (39%) and caused minimal distress. Suggestive clinical features were commonly present, of which orthostatic hypotension was most frequently reported (64%). Ninety-five percent of patients showed EEG/MEG abnormalities, 88% of 123FP-CIT SPECT scans were abnormal, and 53% had a CSF Alzheimer's disease profile. Presence of fluctuations, lower MMSE, parkinsonism, and apathy were associated with higher IADL dependency. Depression, constipation, and lower IADL were associated with lower QoL-AD. Apathy and higher IADL dependency predisposed for higher caregiver burden. CONCLUSION Baseline data of our prospective DLB cohort show clinically relevant associations between symptomatology and disease burden. Cognitive and motor symptoms are related to IADL functioning, while negative neuropsychiatric symptoms and functional dependency are important determinants of QoL and caregiver burden. Follow-up is currently ongoing to address specific gaps in DLB research.
Collapse
|
28
|
Firbank MJ, O'Brien JT, Durcan R, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Lloyd J, Roberts G, Taylor JP, Thomas AJ. Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling. J Neurol 2020; 268:1284-1294. [PMID: 33084940 PMCID: PMC7990749 DOI: 10.1007/s00415-020-10271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
Objective To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate.
Collapse
Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|