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Lookup NU author(s): Dr Calum HamiltonORCiD, Dr Paul DonaghyORCiD, Professor John-Paul TaylorORCiD, Joanna Ciafone, Dr Rory Durcan, Dr Michael FirbankORCiD, Professor Alan ThomasORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Mild cognitive impairment with Lewy bodies (MCI-LB) may be identified prospectively based on the presence of cognitive impairment and several core clinical features (visual hallucinations, cognitive fluctuations, parkinsonism, and REM sleep behavior disorder). MCI-LB may vary in its presenting features, which may reflect differences in underlying pathological pattern, severity, or comorbidity. We aimed to assess how clinical features of MCI-LB accumulate over time, and whether this is associated with rate of cognitive decline. Methods: In this cohort study, 74 individuals seen with MCI-LB prospectively underwent repeated annual cognitive and clinical assessment up to 9 years. Relationships between clinical features (number of core features present, and specific features present) and cognitive change on the Addenbrooke’s Cognitive Examination – Revised (ACE-R) were examined with time-varying mixed models. The accumulation of core clinical features over time was examined with a multi-state Markov model. Results When an individual with MCI-LB endorsed more clinical features they typically experienced a faster cognitive decline (ACE-R Score Difference β = -1.1 [-1.7 to -0.5]), specifically when experiencing visual hallucinations (β = -2.1 [-3.5 to -0.8]) or cognitive fluctuations (β = -3.4 [-4.8 to -2.1]). Individuals with MCI-LB typically acquired more clinical features with the passage of time (25.5% [20.0 to 32.0%] one-year probability), limiting the prognostic utility of baseline-only features. Conclusions: The clinical presentation of MCI-LB may evolve over time. The accumulation of more clinical features of Lewy body disease, in particular visual hallucinations and cognitive fluctuations, may be associated with a worse prognosis in clinical settings.
Author(s): Hamilton CA, Donaghy PC, Taylor JP, Ciafone J, Durcan R, Firbank M, Greenfinch G, Allan LM, O'Brien JT, Thomas AJ
Publication type: Article
Publication status: Published
Journal: Psychological Medicine
Year: 2025
Volume: 55
Online publication date: 24/06/2025
Acceptance date: 04/06/2025
Date deposited: 05/06/2025
ISSN (print): 0033-2917
ISSN (electronic): 1469-8978
Publisher: Cambridge University Press
URL: https://doi.org/10.1017/S0033291725100895
DOI: 10.1017/S0033291725100895
Data Access Statement: Data from the cohorts used in these analyses are available through the Dementias Platform UK data portal.
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