Abstract
Introduction: Currently, there is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. For better diagnosis and prognosis, further exploration of local cortical atrophy patterns and white matter lesions is needed.Methods: We reviewed the outpatient medical records of 97 DLB patients and 173 AD patients from January 2018 to September 2020 along with 30 matched outpatient clinic normal elderly people. MRI visual rating scales, including medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale (GCA-F), posterior atrophy (PA), Fazekas scale, Evans Index and cerebral microbleeds were evaluated and analyzed in DLB and AD patients with different severities and normal controls.Results: Overall, patients with DLB had higher scores on all visual rating scales than the normal controls. Meanwhile, compared with AD, DLB had lower MTA scores in the mild to moderate groups (both p ≤ 0.001), but the GCA-F and PA scores were similar (all p > 0.05). The Fazekas scores in the moderate to severe DLB group were lower than those in the AD group (p = 0.024 and p = 0.027, respectively). In addition, the diagnostic performance and sensitivity of multiple imaging indicators for DLB were better than that of MTA alone (the combination of MTA, GCA-F, PA, Fazekas visual rating scales, AUC = 0.756, 95%CI: 0.700–0.813, sensitivity = 0.647, specificity = 0.804 and MTA visual rating scale, AUC = 0.726, 95%CI: 0.667–0.785, sensitivity = 0.497, specificity = 0.876, respectively).Conclusion: The medial temporal lobe of DLB patients was relatively preserved, the frontal and parietal lobes were similarly atrophied to AD patients, and the white matter hyperintensity was lighter than that in AD patients. Combined multiple visual rating scales may provide a novel idea for the diagnosis of early DLB.
Highlights
There is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB
Several autopsy studies have shown the co-existing of AD pathology may be in DLB patients, and Lewy bodies (LBs) pathology can be observed in some AD patients [12, 13]
The Chinese Mini-mental State Examination (C-MMSE) and MOCA scores were analyzed between AD and DLB patients, and there was no significant difference between the two groups
Summary
There is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. The underlying pathology is sometimes mixed with AD-related pathologies such as extracellular β-amyloid plaques, senile plaques with tau-positive neurites, and neurofibrillary tangles that commonly occur in DLB [4]. Many studies have shown that the core symptoms of DLB, such as RBD and visual hallucinations, are present in AD patients [8, 9]. Several autopsy studies have shown the co-existing of AD pathology may be in DLB patients, and Lewy bodies (LBs) pathology can be observed in some AD patients [12, 13]. The co-pathology in the brains of AD and DLB patients may be a possible reason for overlapping symptoms seen in patients
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