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Abstract
Objectives To investigate the independent and interaction effects of Alzheimer disease (AD) and Lewy body disease (LBD) on cognition and brain atrophy.
Methods We consecutively recruited 38 controls and 108 patients with AD-related cognitive impairment (ADCI) and/or LBD-related cognitive impairment (LBCI) from university-based dementia and movement clinics. Diagnoses of ADCI and LBCI were supported by 18F-florbetaben PET and 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane–PET, respectively. There were 38 controls, 26 patients with pure ADCI (18 mild cognitive impairment [MCI] and 8 dementia), 28 patients with pure LBCI (13 MCI and 15 dementia), and 54 patients with mixed ADCI and LBCI (17 MCI and 37 dementia). We performed group-wise comparisons for neuropsychological z scores and regional cortical thickness. We also evaluated the effects of ADCI and LBCI using general linear models.
Results Compared to the controls, patients in the pure ADCI group and pure LBCI group had focused cortical thinning in the bilateral entorhinal/right anterior temporal cortices and bilateral anteromedial temporal/basal frontal cortices, respectively, while the mixed disease group had additional cortical thinning in the widespread association cortices. The independent effects of ADCI and LBCI on regional cortical thinning overlapped in the widespread association cortices, especially at the bilateral temporoparietal junction and parietal cortices. ADCI and LBCI had independent detrimental effects on the copying item of the Rey-Osterrieth Complex Figure Test.
Conclusions Concomitant ADCI and LBCI are associated with the accentuation of neurodegeneration to widespread association cortices, and both diseases contribute to visuospatial dysfunction.
Glossary
- AD=
- Alzheimer disease;
- ADCI=
- Alzheimer disease–related cognitive impairment;
- CDR-SOB=
- Clinical Dementia Rating Sum of Boxes;
- COWAT=
- Controlled Oral Word Association Test;
- DAT=
- dopamine transporter;
- DLB=
- dementia with Lewy bodies;
- DWMH=
- deep white matter hyperintensities;
- FBB=
- 18F-florbetaben;
- FP-CIT=
- 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane;
- GLM=
- general linear model;
- K-BNT=
- Korean version of the Boston Naming Test;
- K-MMSE=
- Korean version of the Mini-Mental State Examination;
- LB=
- Lewy body;
- LBCI=
- Lewy body disease–related cognitive impairment;
- LBD=
- Lewy body disease;
- MCI=
- mild cognitive impairment;
- PD=
- Parkinson disease;
- PDD=
- Parkinson disease dementia;
- PWMH=
- periventricular white matter hyperintensities;
- RBD=
- REM sleep behavior disorder;
- RCFT=
- Rey-Osterrieth Complex Figure Test;
- RFT=
- random field theory;
- SVLT=
- Seoul Verbal Learning Test;
- UPDRS=
- Unified Parkinson's Disease Rating Scale;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
CME Course: NPub.org/cmelist
- Received July 10, 2018.
- Accepted in final form January 7, 2019.
- © 2019 American Academy of Neurology
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