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A Population-Based Approach to the Argument on Brain-First and Body-First Pathogenesis of Lewy Body Disease.
Camerucci, Emanuele; Mullan, Aidan F; Turcano, Pierpaolo; Stang, Cole D; Bower, James; Benarroch, Eduardo E; Boeve, Bradley F; Savica, Rodolfo.
Afiliação
  • Camerucci E; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
  • Mullan AF; Department of Neurology, Kansas University Medical Center (KUMC), Kansas City, KS, USA.
  • Turcano P; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
  • Stang CD; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
  • Bower J; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
  • Benarroch EE; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
  • Boeve BF; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
  • Savica R; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Ann Neurol ; 96(3): 551-559, 2024 Sep.
Article em En | MEDLINE | ID: mdl-38860478
ABSTRACT

OBJECTIVE:

To explore the clinical progression of the brain-/body-first categories within Lewy body disease (LBD) Parkinson's disease (PD), dementia with Lewy bodies (DLB), and PD dementia.

METHODS:

We used of the Rochester Epidemiology Project to establish a population-based cohort of clinically diagnosed LBD. We used two definitions for differentiating between brain- and body-first LBD a previously hypothesized body-first presentation in patients with rapid eye movement sleep behavior onset before motor symptoms onset; and an expanded definition of body-first LBD when a patient had at least 2 premotor symptoms between constipation, erectile dysfunction, rapid eye movement sleep behavior, anosmia, or neurogenic bladder.

RESULTS:

Brain-first patients were more likely to be diagnosed with PD (RR = 1.43, p = 0.003), whereas body-first patients were more likely to be diagnosed with DLB (RR = 3.15, p < 0.001). Under the expanded definition, there was no difference in LBD diagnosis between brain-first and body-first patients (PD RR = 1.03, p = 0.10; DLB RR = 0.88, p = 0.58) There were no patterns between brain- or body-first presentation, PD dementia under either definition (original p = 0.09, expanded p = 0.97), and no significant difference in motor symptoms between brain-first and body-first.

INTERPRETATION:

Our findings do not support the dichotomous classification of body-first and brain-first LBD with the currently proposed definition. Biological exposures resulting in PD and DLB are unlikely to converge on a binary classification of top-down or bottom-up synuclein pathology. ANN NEUROL 2024;96551-559.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença de Parkinson / Doença por Corpos de Lewy Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Neurol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença de Parkinson / Doença por Corpos de Lewy Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Neurol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos