Abstract
BackgroundCortical and subcortical cognitive impairments have been found in dementia with Lewy bodies (DLB). Roughly, they comprise visuoconstructive and executive dysfunction, whereas memory would remain relatively spared. However, the cognitive profile of patients with prodromal DLB remains poorly illustrated to date.MethodsWe included 37 patients with prodromal DLB (age 67.2 ± 8.6 years, 18 men, Mini Mental State Examination [MMSE] score 27.4 ± 2) and 29 healthy control subjects (HCs; age 68.8 ± 7.9 years, 15 men, MMSE score 29.0 ± 0.9). They were presented with an extensive neuropsychological test battery to assess memory; speed of processing; executive function; visuoperceptual, visuospatial and visuoconstructive abilities; language; and social cognition.ResultsCompared with HCs, patients had lower scores on a visual recognition memory test (Delayed Matching to Sample-48 items; p ≤ 0.021) and lower free recall (all p ≤ 0.035), but not total recall, performance on a verbal episodic memory test (Free and Cued Selective Reminding Test). Short-term memory (p = 0.042) and working memory (p = 0.002) scores were also lower in patients. Assessment of executive function showed no slowing but overall lower performance in patients than in HCs (all p ≤ 0.049), whereas assessment of instrumental function yielded mixed results. Indeed, patients had lower scores on language tests (p ≤ 0.022), apraxia for pantomime of tool use (p = 0.002) and imitation of meaningless gesture (p = 0.005), as well as weakened visuospatial abilities (p = 0.047). Visuoconstruction was also impaired in patients. However, visuoperceptual abilities did not differ between groups. Finally, theory of mind abilities were lower in patients than in HCs (p < 0.05), but their emotion recognition abilities were similar.ConclusionsThis study presents the cognitive profile in patients with prodromal DLB. In line with the literature on DLB with dementia, our results show lower performance on tests of executive function and visuoconstruction. However, we found, from a prodromal stage of DLB, memory (free recall and visual recognition) and social cognition deficits, as well as weakened visuospatial and praxic abilities.
Highlights
Cortical and subcortical cognitive impairments have been found in dementia with Lewy bodies (DLB)
In addition to the impairment demonstrated by patients with DLB highlighted above, we found significant differences between patients and Healthy control subjects (HC) on other tests assessing memory, namely in free recall (FR) of the RL/RI16, reflecting retrieval of episodic memory (p = 0.006, p = 0.001, p = 0.035 and p = 0.003, for FR1, FR2, FR3 and delayed FR, respectively) and in short-term memory (p = 0.042), but not for total recall (TR) of the RL/RI-16
It has even been suggested that a reduced number of angles on the Mini Mental State Examination (MMSE) pentagon copy could be a marker of prodromal DLB, with a specificity of 91% in discrimination from Alzheimer’s disease (AD) [53]
Summary
Cortical and subcortical cognitive impairments have been found in dementia with Lewy bodies (DLB). They comprise visuoconstructive and executive dysfunction, whereas memory would remain relatively spared. Research on prodromal DLB—that is, the disease is present but cognitive impairment is not sufficient to lead to functional deficits in activities of daily living [4]—is relatively recent. We recently demonstrated in a neuroimaging study that patients with prodromal DLB have thinner grey matter in the right insula, superior temporal and orbitofrontal cortices than healthy control subjects (HCs) and patients with prodromal AD [11]. We showed that patients with prodromal DLB present with diminished grey matter volumes of bilateral insulae and right anterior cingulate cortex compared with HCs [12]. Functional imaging studies using [18F]fluoro-D-glucose positron emission tomography showed that patients with prodromal DLB symptoms have occipital hypometabolism [13]
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