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Outcomes of Patients With Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease at 3 and 5 Years After Diagnosis

Lookup NU author(s): Dr Calum HamiltonORCiD, Dr Paul DonaghyORCiD, Dr Rory Durcan, Dr Joanna Ciafone, Dr Kirsty OlsenORCiD, Dr Gemma Roberts, Dr Michael FirbankORCiD, Dr Louise Allan, Professor John-Paul TaylorORCiD, Professor John O'Brien, Professor Alan ThomasORCiD

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

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 two key milestones, three- and five-years post-diagnosis, to examine classification stability over time, and rates of adverse outcomes (dementia or death). Methods: MCI participants were prospectively recruited from North East England and differentially classified as MCI due to Alzheimer’s 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 baseline MCI participants (54 MCI-AD, 29 possible MCI-LB, and 69 probable MCI-LB), 126 were followed for up to three years and 95 for five years. 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 three 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 three years. Dementia occurred in 47% of MCI-AD over the same duration (OR = 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 three 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.

Publication metadata

Author(s): Hamilton CA, Donaghy PC, Durcan R, Ciafone J, Olsen K, Roberts G, Firbank M, Allan LM, Taylor JP, O'Brien JT, Thomas AJ

Publication type: Article

Publication status: Published

Journal: Neurology

Year: 2024

Volume: 103

Issue: 2

Print publication date: 23/07/2024

Online publication date: 13/06/2024

Acceptance date: 26/03/2024

Date deposited: 16/05/2024

ISSN (print): 0028-3878

ISSN (electronic): 1526-632X

Publisher: Wolters Kluwer Health

URL: https://doi.org/10.1212/WNL.0000000000209499

DOI: 10.1212/WNL.0000000000209499

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