Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies.
Donaghy, Paul C
Barker, Sally AH
Allan, Louise M
Yarnall, Alison J
Thomas, Alan J
Int J Geriatr Psychiatry
John Wiley and Sons
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Hamilton, C. A., Frith, J., Donaghy, P. C., Barker, S. A., Durcan, R., Lawley, S., Barnett, N., et al. (2022). Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies.. Int J Geriatr Psychiatry https://doi.org/10.1002/gps.5703
OBJECTIVES: Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI-LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI-AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI-LB from MCI-AD. METHODS: Ninety-three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31-item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI-AD or MCI-LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub-scales were assessed, controlling for age. RESULTS: Age-adjusted severity of overall autonomic symptomatology was greater in MCI-LB (Ratio = 2.01, 95% CI: 1.37-2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI-AD did not have significantly higher autonomic symptom severity than controls overall. A cut-off of 4/5 on the COMPASS was sensitive to MCI-LB (92%) but not specific to this (42% specificity vs. MCI-AD and 52% vs. healthy controls). CONCLUSIONS: Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI-AD, but such autonomic symptoms are not a specific finding. The COMPASS-31 may therefore have value as a sensitive screening test for early-stage Lewy body disease.
This work was supported by Alzheimer’s Research UK (ARUK-PG2015-13) and by the NIHR Newcastle Biomedical Research Centre. GE Healthcare provided the FP-CIT ligand for this investigator-led study.
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External DOI: https://doi.org/10.1002/gps.5703
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335142
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