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Observational Study
. 2024 Jul 23;103(2):e209499.
doi: 10.1212/WNL.0000000000209499. Epub 2024 Jun 13.

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

Calum A Hamilton  1 , Paul C Donaghy  1 , Rory Durcan  1 , Joanna Ciafone  1 , Kirsty Olsen  1 , Gemma Roberts  1 , Michael J Firbank  1 , Louise M Allan  1 , John-Paul Taylor  1 , John T O'Brien  1 , Alan J Thomas  1
Affiliations
Observational Study

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

Calum A Hamilton et al. Neurology. .

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.

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Conflict of interest statement

C.A. Hamilton has received presenter honoraria from Dementias Platform UK, and research grants from Alzheimer's Research UK North Network. P.C. Donaghy has received research support from the Medical Research Council (grant MR/W000229/1), research grants from Alzheimer's Society and Alzheimer's Research UK, and honoraria (paid to institution) from the Lewy Body Academy. G. Roberts is funded part time by a project grant from the Alzheimer's Society, is in receipt of an MRC Confidence in Concept grant, and has received speaker honoraria from G.E. Healthcare (paid to Newcastle Hospitals). L.M. Allan has received research grants from NIHR (Peninsular NIHR Applied Research Collaboration and NIHR, Exeter Biomedical Research Centre), MRC, ESRC, the Alzheimer's Society, and Parkinson's UK. J.-P. Taylor has received speaker honoraria from Bial and GE Healthcare, has acted as a consultant for Sosei-Heptares, EIP Pharma, and Kyowa-Kirin, and has research grants from NIHR, the Alzheimer's Society, the Lewy Body Society and Alzheimer's Research UK. J.T. O'Brien has acted as a consultant for TauRx, Novo Nordisk, Biogen, Roche, Lilly, and GE Healthcare, and has received grant or academic support from Avid/Lilly, Merck and Alliance Medical. A.J. Thomas has received grants from NIHR, MRC, ESRC, ABBUK, the Alzheimer's Society, Alzheimer's Research UK, the Lewy Body Society, and support for research consumables from GE Healthcare. The other authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Flowchart for Pooled MCI Cases From Lewypro (n = 75) and SUPErB (n = 77) Cohort Studies, With Data Missingness Because of Withdrawal, Loss to Follow-Up, or Excluded Etiology
AD = Alzheimer disease; FTD = frontotemporal dementia; MCI = mild cognitive impairment; MCI-AD = MCI due to AD; MCI-LB = MCI with Lewy bodies; VCI = vascular cognitive impairment.
Figure 2
Figure 2. (A) Baseline and 3-Year Follow-Up Classifications (n = 120) and (B) Baseline MCI and Terminal Dementia Classifications, Including Dementia Occurring Beyond 5 Years
AD = Alzheimer disease; FTD = frontotemporal dementia; MCI = mild cognitive impairment; MCI-AD = MCI due to AD; MCI-LB = MCI with Lewy bodies; PSP = progressive supranuclear palsy; SCI = subjective-only impairment; VCI = vascular cognitive impairment.
See this image and copyright information in PMC

References

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