Progression of clinical features in Lewy body dementia can be detected over six months

Objective: This study aimed to quantify the trajectory and magnitude of
change of the key clinical features and corresponding symptom domains of
Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD)
including global cognition, parkinsonism, recurrent visual hallucinations,
cognitive fluctuations and sleep disturbance. Methods: 116 patients with
Lewy body dementia (DLB=72, PDD=44) underwent assessment at baseline, 3
and 6 months as part of a prospective multi-centre randomized control
trial. Linear mixed models were constructed for core outcome measures
using the Mini-Mental State Examination (MMSE), motor section of the
Unified Parkinson’s disease rating scale (UPDRS-III), Dementia Cognitive
Fluctuations Scale (DCFS) and the Neuropsychiatric Inventory (NPI).
Results: Within the timeframe of our study (6 months) we were able to
identify a significant cognitive decline of 1.3 points on the MMSE
(P=0.002) and significant worsening of motor parkinsonism with an increase
in UPDRS-III score of 3.2 points (P=0.018). Fluctuation severity also
increased using the DCFS with a 6 month change in score of 1.3 points
(P=0.001). Uniquely, a signal for increased severity of sleep symptoms of
1.2 points (NPI-sleep) was also detectable (P=0.04). Significant changes
in neuropsychiatric symptoms were not detected. There was no difference in
rates of change of scores between DLB and PDD. Conclusions: Clinically
significant rates of change in core clinical features can be detected and
quantified in Lewy body dementia over a relatively short period (6 months)
using common clinical instruments, and thus may be useful as clinical
endpoints for therapeutic trials of disease modifying and symptomatic
agents. --