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Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies

Lookup NU author(s): Dr Calum Hamilton, Dr James FrithORCiD, Dr Paul Donaghy, Dr Rory Durcan, Dr Sarah Lawley, Nicola Barnett, Dr Michael FirbankORCiD, Dr Gemma RobertsORCiD, Professor John-Paul TaylorORCiD, Dr Louise Allan, Professor John O'Brien, Professor Alison Yarnall, Professor Alan ThomasORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


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). MCI 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: MCI-LB 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.

Publication metadata

Author(s): Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett NA, Firbank M, Roberts G, Taylor JP, Allan LM, O'Brien JT, Yarnall AJ, Thomas AJ

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2022

Volume: 37

Issue: 4

Print publication date: 01/04/2022

Online publication date: 18/03/2022

Acceptance date: 13/03/2022

Date deposited: 14/03/2022

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley & Sons, Inc.


DOI: 10.1002/gps.5703


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Funder referenceFunder name
Alzheimer's Research UK
GE Healthcare
NIHR Newcastle Biomedical Research Centre