Progression to Dementia in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease

Calum A Hamilton; Fiona E Matthews; Paul C Donaghy; John-Paul Taylor; John T O'Brien; Nicola Barnett; Kirsty Olsen; Rory Durcan; Gemma Roberts; Joanna Ciafone; Sally A H Barker; Michael Firbank; Ian G McKeith; Alan J Thomas

doi:10.1212/WNL.0000000000012024

Progression to Dementia in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease

Neurology. 2021 May 31;96(22):e2685-e2693. doi: 10.1212/WNL.0000000000012024.

Affiliations

¹ From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK. C.Hamilton3@newcastle.ac.uk.
² From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK.

Abstract

Objective: To determine whether mild cognitive impairment with Lewy bodies or mild cognitive impairment with Alzheimer disease differ in their rates of clinical progression to dementia, we undertook longitudinal observation of mild cognitive impairment cases with detailed clinical assessment of Lewy body diagnostic characteristics.

Methods: Two prospective longitudinal cohorts including 111 individuals ≥60 years of age with mild cognitive impairment were assessed annually to track cognitive and clinical progression, including the presence or absence of core clinical features and proposed biomarkers of dementia with Lewy bodies. Multistate modeling was used to assess the associations of diagnostic characteristics of dementia with Lewy bodies with clinical progression from mild cognitive impairment to dementia, with death as a competing outcome.

Results: After a mean follow-up of 2.2 years (range 1-6.7 years), 38 of the 111 (34%) participants progressed to dementia: 10 with AD, 3 with possible dementia with Lewy bodies, and 25 with probable dementia with Lewy bodies. The presence of any Lewy body disease characteristic was associated with an increased hazard of transition to dementia; this risk further increased as more diagnostic characteristics were observed (hazard ratio 1.33 per characteristic, 95% confidence interval [CI] 1.11-1.60) and was especially high for those experiencing complex visual hallucinations (hazard ratio 1.98, 95% CI 0.92-4.29) or cognitive fluctuations (hazard ratio 3.99, 95% CI 2.03-7.84).

Conclusions: Diagnostic characteristics of Lewy body disease are associated with an increased risk of transition from mild cognitive impairment to dementia.