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.
Conclusion 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.
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