White matter hyperintensities in cognitive impairment with Lewy body disease: a multicentre study

Jinghuan Gan; Zhihong Shi; Shuai Liu; Xudong Li; Yiming Liu; Hongcan Zhu; Lu Shen; Guili Zhang; Hao Lu; Baozhi Gang; Zhichao Chen; Yong Ji

doi:10.1111/ene.16002

White matter hyperintensities in cognitive impairment with Lewy body disease: a multicentre study

Eur J Neurol. 2023 Dec;30(12):3711-3721. doi: 10.1111/ene.16002. Epub 2023 Aug 7.

Authors

Jinghuan Gan¹, Zhihong Shi², Shuai Liu², Xudong Li³, Yiming Liu⁴, Hongcan Zhu⁵, Lu Shen⁶, Guili Zhang³, Hao Lu⁷, Baozhi Gang⁸, Zhichao Chen¹, Yong Ji²

Affiliations

¹ Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China.
³ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, Beijing, China.
⁴ Department of Neurology, Qilu Hospital, Shandong University, Shandong, China.
⁵ Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁶ Department of Neurology, Xiangya Hospital, Central South University, Hunan, China.
⁷ Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China.
⁸ Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin, China.

PMID: 37500565
DOI: 10.1111/ene.16002

Abstract

Background and purpose: White matter hyperintensities (WMHs) are associated with cognitive deficits and worse clinical outcomes in dementia, but rare studies have been carried out of cognitive impairment in Lewy body disease (CI-LB) patients. The objective was to investigate the associations between WMHs and clinical manifestations in patients with CI-LB.

Methods: In this retrospective multicentre cohort study, 929 patients (486 with dementia with Lewy bodies [DLB], 262 with Parkinson's disease dementia [PDD], 74 with mild cognitive impairment [MCI] with Lewy bodies [MCI-LB] and 107 with Parkinson's disease with MCI [PD-MCI]) were analysed from 22 memory clinics between January 2018 and June 2022. Demographic and clinical data were collected by reviewing medical records. WMHs were semi-quantified according to the Fazekas method. Associations between WMHs and clinical manifestations were investigated by multivariate linear or logistic regression models.

Results: Dementia with Lewy bodies patients had the highest Fazekas scores compared with PDD, MCI-LB and PD-MCI. Multivariable regressions showed the Fazekas score was positively associated with the scores of Unified Parkinson's Disease Rating Scale Part III (p = 0.001), Hoehn-Yahn stage (p = 0.004) and total Neuropsychiatric Inventory (p = 0.001) in MCI-LB and PD-MCI patients. In patients with DLB and PDD, Fazekas scores were associated with the absence of rapid eye movement sleep behaviour disorder (p = 0.041) and scores of Unified Parkinson's Disease Rating Scale Part III (p < 0.001), Hoehn-Yahn stage (p < 0.001) and the Montreal Cognitive Assessment (p = 0.014).

Conclusion: White matter hyperintensity burden of DLB was higher than for PDD, MCI-LB and PD-MCI. The greater WMH burden was significantly associated with poorer cognitive performance, worse motor function and more severe neuropsychiatric symptoms in CI-LB.

Keywords: Fazekas scale; Lewy body disease; mild cognitive impairment; neuropsychiatric symptoms; white matter hyperintensities.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Alzheimer Disease* / complications
Cognitive Dysfunction* / diagnosis
Cohort Studies
Dementia* / complications
Humans
Lewy Body Disease* / complications
Lewy Body Disease* / diagnostic imaging
Parkinson Disease* / complications
White Matter* / diagnostic imaging