Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies

Abstract

Objectives Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI‐LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI‐AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI‐LB from MCI‐AD. Methods Ninety‐three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31‐item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI‐AD or MCI‐LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub‐scales were assessed, controlling for age. Results Age‐adjusted severity of overall autonomic symptomatology was greater in MCI‐LB (Ratio = 2.01, 95% CI: 1.37–2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI‐AD did not have significantly higher autonomic symptom severity than controls overall. A cut‐off of 4/5 on the COMPASS was sensitive to MCI‐LB (92%) but not specific to this (42% specificity vs. MCI‐AD and 52% vs. healthy controls). Conclusions Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI‐AD, but such autonomic symptoms are not a specific finding. The COMPASS‐31 may therefore have value as a sensitive screening test for early‐stage Lewy body disease.

Research diagnostic criteria for mild cognitive impairment with Lewy bodies: A systematic review and meta‐analysis

“…From our meta‐analysis, there is clear evidence for the inclusion of anxiety, apathy, depression, delusions, constipation, and difficulty emptying the bladder as supportive symptoms of MCI‐LB. There is also consistent evidence of increased overall autonomic symptoms in MCI‐LB compared with MCI‐AD 25, 30, 31 …”

“…Autonomic signs: Rates of orthostatic hypotension varied considerably between two studies in MCI‐LB (19%, 43%) and MCI‐AD (18%, 26%) 23, 30 . Other studies have found lower heart rate variability 19 and abnormal blood pressure responses to the Valsalva maneuver, but not abnormal heart rate responses in MCI‐LB compared with MCI‐AD 32 …”

“…14%) were higher in MCI-LB compared with MCI-AD (Table 2). Two studies examined the discriminant ability of overall scores in autonomic symptom scales to differentiate between MCI-LB and MCI-AD, finding a similar area under the receiver operating characteristic (AUROC) curve of 0.68 using the Composite Autonomic Symptoms score 30 and 0.76 using the Scales for Outcomes in Parkinson's Disease -Autonomic Dysfunction. 31 Autonomic signs: Rates of orthostatic hypotension varied considerably between two studies in MCI-LB (19%, 43%) and MCI-AD (18%, 26%).…”

“…There is also consistent evidence of increased overall autonomic symptoms in MCI-LB compared with MCI-AD. 25,30,31 Non-visual hallucinations and delusions are not commonly reported in MCI-LB. The low rates of symptoms of psychosis in MCI-LB may be because these features tend to present later in disease, or because MCI-LB cohorts are currently not identifying cases with a concurrent psychiatric presentation.…”

Autonomic dysregulation, cognition and fatigue in people with depression and in active and healthy controls: observational cohort study

“…To put our results in perspective, the median COMPASS-31 scores in our sample (30 and 23 for the depression and active controls groups respectively) are more severe than those of a small sample of patients with mild cognitive impairment with Lewy bodies (median 12.5). 6 The THINC-it has been demonstrated to be valid for the cognitive assessment of people with depression 23 and healthy controls. 24 The PDQ-5, derived from the Perceived Deficits Questionnaire (PDQ), 25 is the only self-report component of the THINC-it.…”