Comparative Analysis Of Follow-up In Patients With Alzheimer’s Disease And Dementia With Lewy Body

Objective: By comparing the cognitive and psychobehavioral symptoms of patients with Alzheimer’s disease(AD)and dementia with Lewy body(DLB),from initial visit and follow-up of 6(±2)months,12(±2)months,36(±2)months and 60(±2)months,to explore the progress regularity and the key identification points at early-stage in AD and DLB.Methods: According to the DSM-IV guidelines for dementia,474 cases of probable AD and 35 cases of probable DLB were selected from the memory clinic in Tianjin Huanhu hospital from April 2011 to April 2019.The included population were followed up at the initial visit,the 6(±2)months,12(±2)months,36(±2)months and 60(±2)months.Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(Mo CA),Neuropsychiatric Inventory(NPI),Clock Drawing Task(CDT),activities of daily living(ADL)and Clinical Dementia Rating(CDR)were evaluated to continuously observe patients’ cognition,mental symptoms,daily living ability and comorbidity.According to the completion of follow-up,the clinical situation between AD and DLB groups was analyzed to describe the overall changes of the disease.At the same time,t-test was used to compare the difference of cognitive and mental symptoms between mild AD and DLB.Regression analysis was used to compare the differential diagnostic significance of irritability symptoms between the two groups in mild AD and DLB.Results: 474 AD and 35 DLB patients were included in the study.The average age of initial diagnosis in AD group was 71.42(±9.28)years old,and 53.4% of them were women.The initial diagnosis age of DLB group was 71.2(±8.86)years old,and the proportion of women(37.1%)was lower than that of men.The distribution of antiparkinsonian drugs(p(27)0.001),antipsychotic drugs(p(27)0.001)and severity(p = 0.029)were statistically different among newly diagnosed patients.MMSE(16.63±7.59 vs.15.74±6.77,p=0.064),MOCA(11.15±8.159 vs.10.18±6.04,p=0.002),CDT(1.97±1.49 vs.1.66±1.38,p=0.660)and ADL(38.84±17.54 vs.35.4±12.93,p=0.254)were higher than those of AD group.There were significant statistical differences in irritability/emotional instability(33.2% vs.11.4%,p=0.009)and abnormal exercise behavior(27.1% vs.11.4%,p=0.046)in NPI.The follow-up compliance of female patients is worse than that of male patients,and their educational level is more than 9 years.The follow-up compliance of married patients is good.With the development of the disease course,the cognitive and daily living ability between the two groups decreased.MMSE and ADL scores in DLB group showed a fluctuating trend,with a larger variation than AD.The proportion of neuropsychiatric symptoms in the two groups gradually increased.The proportion of delusion(p=0.029),anxiety state(p=0.034)and disinhibition(p=0.014)and appetite/eating disorder(p=0.014)in AD group increased significantly.Of 135 cases of mild AD and 17 cases of mild DLB,2 cases in DLB group died of cerebrovascular diseases during the follow-up period.The diabetes rate in mild AD group was 13.3%,significantly lower than that in mild DLB group(35.3%,p=0.019).There was no significant difference in MMSE,Mo CA,ADL and CDT scores between the two groups.However,in NPI,the mental symptoms in AD group are more prominent than those in DLB group,only irritability/emotional instability have statistical difference(p=0.044),while the other symptoms have little difference.It takes about(13.76±12.86)months for AD patients to progress from mild to moderate,and about(49.43±13.2)months for AD patients to progress to severe.The cognitive course of mild DLB patients progresses faster than AD,and mental symptoms change obviously,especially hallucinations(17.6% vs.50.0%),delusions(17.6% vs.100.0%),anxiety(17.6% vs.100.0%),apathy/indifference(35.3% vs.100.0%),disinhibition(0.0% vs.50.0%),irritability/emotional instability(11.8% vs.50.0%%),and appetite/or eating disorders(5.9% vs.100.0%).Conclusion: Long-term follow-up is of great significance for the clear diagnosis of AD and DLB.Cognitive symptoms and psychobehavioral symptoms play an important role in the preliminary diagnosis of diseases.AD and DLB can be differentiated by observing whether the course of diseases fluctuates,the degree of change of the proportion of psychobehavioral symptoms and the progression time of the disease.