Exercise for Individuals with Lewy Body Dementia: A Systematic Review

Background
Individuals with Lewy body Dementia (LBD), which encompasses both Parkinson disease dementia (PDD) and Dementia with Lewy Bodies (DLB) experience functional decline through Parkinsonism and sedentariness exacerbated by motor, psychiatric and cognitive symptoms. Exercise may improve functional outcomes in Parkinson’s disease (PD), and Alzheimer’s disease (AD). However, the multi-domain nature of the LBD cluster of symptoms (physical, cognitive, psychiatric, autonomic) results in vulnerable individuals often being excluded from exercise studies evaluating physical function in PD or cognitive function in dementia to avoid confounding results. This review evaluated existing literature reporting the effects of exercise interventions or physical activity (PA) exposure on cluster symptoms in LBD.
Methods
A high-sensitivity search was executed across 19 databases. Full-length articles of any language and quality, published or unpublished, that analysed effects of isolated exercise/physical activity on indicative Dementia with Lewy Bodies or PD-dementia cohorts were evaluated for outcomes inclusive of physical, cognitive, psychiatric, physiological and quality of life measures. The protocol for this review (Reg. #: CRD42015019002) is accessible at http://www.crd.york.ac.uk/PROSPERO/.
Results
111,485 articles were initially retrieved; 288 full articles were reviewed and 89.6% subsequently deemed ineligible due to exclusion of participants with co-existence of dementia and Parkinsonism. Five studies (1 uncontrolled trial, 1 randomized controlled trial and 3 case reports) evaluating 16 participants were included. Interventions were diverse and outcome homogeneity was low. Habitual gait speed outcomes were measured in 13 participants and increased (0.18m/s, 95% CI -0.02, 0.38m/s), exceeding moderate important change (0.14m/s) for PD cohorts. Other outcomes appeared to improve modestly in most participants.
Discussion
Scarce research investigating exercise in LBD exists. This review confirms exercise studies in PD and dementia consistently exclude LBD participants. Results in this cohort must be treated with caution until robustly designed, larger studies are commissioned to explore exercise efficacy, feasibility and clinical relevance.

背景
路易体痴呆（Lewy body Dementia, LBD）涵盖帕金森病痴呆（Parkinson disease dementia, PDD）与路易体痴呆（Dementia with Lewy Bodies, DLB）两类亚型，患者会出现帕金森症候群与久坐不动状态，进而引发功能衰退，而运动障碍、精神症状及认知症状会进一步加剧这一进程。现有研究表明，运动可改善帕金森病（Parkinson’s disease, PD）与阿尔茨海默病（Alzheimer’s disease, AD）患者的功能结局。然而，路易体痴呆的症候群具有多维度特征，涉及躯体、认知、精神及自主神经功能多个领域，导致此类易感人群常被排除在针对帕金森病运动功能或痴呆认知功能的运动研究之外，以避免研究结果出现混杂偏倚。本综述旨在评估现有文献中，关于运动干预或体力活动（physical activity, PA）暴露对路易体痴呆多维度症候群影响的研究进展。
方法
本研究通过19个数据库开展高灵敏度检索。检索范围涵盖无论语种、质量高低，已发表或未发表的全文文献，筛选标准为：分析孤立性运动/体力活动对确诊路易体痴呆或帕金森病痴呆队列的干预效果，且结局指标包含躯体、认知、精神、生理及生活质量相关维度。本综述的研究方案（注册号：CRD42015019002）可于http://www.crd.york.ac.uk/PROSPERO/ 查阅。
结果
初始检索共获取111485篇文献，经筛选后对288篇全文文献进行评审，其中89.6%因研究对象排除了同时合并痴呆与帕金森症候群的患者而被判定为不符合纳入标准。最终纳入5项研究（含1项非对照试验、1项随机对照试验及3例病例报告），共涉及16名受试者。干预措施种类多样，结局指标的同质性较低。其中13名受试者接受了习惯性步速评估，其步速提升了0.18m/s（95%置信区间：-0.02~0.38m/s），超过帕金森病队列的中度重要临床变化阈值（0.14m/s）。其余结局指标在多数受试者中均呈现出小幅改善趋势。
讨论
目前针对路易体痴呆患者开展运动相关研究的文献极为匮乏。本综述证实，针对帕金森病与痴呆的运动研究通常会排除路易体痴呆患者。在开展设计严谨的大规模研究以验证运动干预的有效性、可行性及临床相关性之前，对本队列研究的结果需谨慎解读。