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Clinical Manifestations.

Giulia Zazzaro1, Desirée Conti1, Massimiliano Panigutti1

  • 1Fondazione Santa Lucia IRCCS, Rome, Italy.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Prodromal dementia with Lewy bodies (pro-DLB) patients exhibit distinct cognitive and brain changes compared to Alzheimer's disease. Neuropsychological testing should focus on attention, visuospatial skills, and executive functions for accurate pro-DLB diagnosis.

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Area of Science:

  • Neurology
  • Neuroscience
  • Cognitive Science

Background:

  • The prodromal stage of dementia with Lewy bodies (pro-DLB) is recently defined, but its neuropsychological and neuroimaging profile across different clinical onsets remains under-investigated.
  • Understanding these profiles is crucial for early diagnosis and differentiating pro-DLB from other neurodegenerative conditions like Alzheimer's disease (AD).

Purpose of the Study:

  • To clarify the specific neuropsychological and neuroimaging markers differentiating pro-DLB from mild cognitive impairment due to AD (MCI-AD).
  • To investigate how clinical onset (MCI-DLB, psychiatric-onset, delirium-onset) influences these markers in pro-DLB.

Main Methods:

  • A cohort of 26 pro-DLB patients (including MCI-DLB, psychiatric-onset, and delirium-onset) and 15 MCI-AD patients underwent comprehensive neuropsychological assessments.
  • Structural MRI and Voxel-Based Morphometry (VBM) were used to compare gray matter volume differences between pro-DLB, MCI-AD patients, and healthy controls.

Main Results:

  • Pro-DLB patients demonstrated significant deficits in alertness, working memory, visuospatial processing, abstract reasoning, and planning compared to MCI-AD.
  • Neuropsychiatric symptoms such as anxiety and hallucinations were more prevalent in pro-DLB.
  • Brain imaging revealed increased atrophy in occipital, parietal, and frontal regions, including the nucleus accumbens, with relative preservation of the medial temporal lobe in pro-DLB compared to MCI-AD.

Conclusions:

  • The neuropsychological profile of pro-DLB is characterized by deficits in visuospatial abilities, executive functions, and attention, consistent with the full-blown disease.
  • Neuroimaging findings correlate with observed cognitive and neuropsychiatric symptoms, supporting distinct regional atrophy patterns in pro-DLB phenotypes.
  • Targeted neuropsychological assessments focusing on these domains are recommended for accurate pro-DLB identification.