Using Neuropsychological Profiles to Differentiate MCI Progression to Alzheimer Disease vs Lewy Body Dementia

Using neuropsychologic profiles to predict the progression of mild cognitive impairment (MCI) to Alzheimer disease (AD) or Lewy body dementia (LBD) is challenging, but it may be useful for early therapeutic interventions, according to study results presented at the International Congress of Parkinson’s Disease and Movement Disorders (MDS) Virtual Congress 2021, held from September 17 to 22, 2021.

Clinicians typically rely on both clinical symptoms and neurocognitive assessment and neuroimaging to predict progression to AD or LBD in patients with mild cognitive impairment. Early differentiation of AD from LBD can help identify treatment approaches that can delay disease progression.

The current study was aimed at understanding the specific neuropsychologic features that could help distinguish between the 2 neurologic diseases, AD and LBD.

A researcher from National and Kapodistrian University of Athens in Greece searched publication databases for studies published after 2005 that assessed clinical or neuropsychologic features that may help distinguish between progression to AD or LBD among patients with MCI. A total of 17 articles were included in this review.

The main consensus from these articles was that episodic waves and recognition memory deficits are more characteristic of progression to AD. This pattern contrasts with that of progression to DLB, in which patients are more likely to exhibit executive functional, attentional, and visuospatial impairments coupled with difficulties in letter fluency and concentration.

In addition, amnestic symptoms can be used for patient stratification, in which patients with MCI with memory loss are more likely to progress to AD compared with LBD.

The author of the review observed that cognitive scoring alone was insufficient to robustly predict disease progression. However, quantitative electroencephalogram assessment may allow for better patient stratification. Patients with MCI who present with preserved hippocampal volumes were more likely to progress to LBD than AD. A more robust prediction can be made when combining these methods, in which patients who present with preserved hippocampal volumes and are not amnestic have a higher likelihood of progression to LBD.

The review author noted that some published evidence was contradictory and that predicting progression to AD or LBD among patients with MCI remained challenging.

“More studies are needed, since there are some conflicting findings and, at present, the combination of clinical symptoms with neurocognitive assessment and neuroimaging is the ideal method for the prediction of MCI progression to various types of dementia,” the researcher concluded.

Reference

Voskou P. Differentiation of mild cognitive impairment (MCI) progression to Alzheimer Disease (AD) vs dementia with Lewy bodies (DLB): is this possible neuropsychologically? Presented at: MDS Virtual Congress 2021; September 17-22, 2021. Abstract 82.