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Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease.

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Peer-reviewed

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Article

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Authors

Donaghy, Paul C 
Taylor, John-Paul 
O'Brien, John T 

Abstract

BACKGROUND: Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). METHODS: A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function. RESULTS: Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline. CONCLUSIONS: These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms - particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.

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Keywords

Alzheimer's disease, dementia with Lewy bodies, latent class mixture modelling, longitudinal decline, mild cognitive impairment, Aged, Aged, 80 and over, Alzheimer Disease, Cognitive Dysfunction, Disease Progression, England, Female, Humans, Latent Class Analysis, Lewy Bodies, Lewy Body Disease, Longitudinal Studies, Male, Middle Aged, Prospective Studies

Journal Title

Psychol Med

Conference Name

Journal ISSN

0033-2917
1469-8978

Volume Title

Publisher

Cambridge University Press (CUP)

Rights

All rights reserved