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August 11, 2020; 95 (6) Article

Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies

Jessica Joanne van der Zande, Alida A. Gouw, Inger van Steenoven, Marleen van de Beek, View ORCID ProfilePhilip Scheltens, Cornelis Jan Stam, Afina Willemina Lemstra
First published July 7, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009977
Jessica Joanne van der Zande
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Alida A. Gouw
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Inger van Steenoven
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Marleen van de Beek
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Philip Scheltens
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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  • ORCID record for Philip Scheltens
Cornelis Jan Stam
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Afina Willemina Lemstra
From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
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Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies
Jessica Joanne van der Zande, Alida A. Gouw, Inger van Steenoven, Marleen van de Beek, Philip Scheltens, Cornelis Jan Stam, Afina Willemina Lemstra
Neurology Aug 2020, 95 (6) e662-e670; DOI: 10.1212/WNL.0000000000009977

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Abstract

Objective Early biomarkers for dementia with Lewy bodies (DLB) are lacking. To determine whether EEG differentiates the prodromal phase of DLB from other causes of mild cognitive impairment (MCI) and whether EEG is predictive for time to conversion from MCI to DLB, we compared EEGs and clinical follow-up of patients with MCI due to DLB with those of patients with MCI due to Alzheimer disease (MCI-AD).

Methods We compared 37 patients with MCI who developed DLB during follow-up or had an abnormal 123I-PF-CIT SPECT scan (MCI-DLB) with 67 age-matched patients with MCI-AD. EEGs were assessed visually with a score of increasing abnormality (range 1–5). We performed fast Fourier transform to analyze the power spectrum. With survival analyses, EEG characteristics were related to time to progression to dementia.

Results The visual EEG score was higher in MCI-DLB (score >2 in 60%) compared to MCI-AD (score >2 in 8%, p < 0.001). We found frontal intermittent delta activity in 22% of MCI-DLB, not in MCI-AD. Patients with MCI-DLB had a lower peak frequency (7.5 [6.0–9.9] Hz vs 8.8 [6.8–10.2] in MCI-AD, p < 0.001) and more slow-wave activity. Several individual EEG measures showed good performance to discriminate MCI-DLB from MCI-AD (areas under the curve up to 0.94). In MCI-DLB, high visual EEG score, diffuse abnormalities, and low α2 power were related to time to progression to dementia (hazard ratios 4.1, 9.9, 5.1, respectively).

Conclusions Profound EEG abnormalities are already present in the prodromal stage of DLB and have diagnostic and prognostic value.

Classification of evidence This study provides Class III evidence that EEG abnormalities are more common in MCI-DLB than MCI-AD.

Glossary

AD=
Alzheimer disease;
ADC=
Amsterdam Dementia Cohort;
AUC=
area under the receiver operating characteristic curve;
CI=
confidence interval;
DFV=
dominant frequency variability;
DLB=
dementia with Lewy bodies;
FIRDA=
frontal intermittent rhythmic delta activity;
IQR=
interquartile range;
MCI=
mild cognitive impairment;
MMSE=
Mini-Mental State Examination;
OR=
odds ratio;
PD=
Parkinson disease;
qEEG=
quantitative EEG;
RBD=
REM sleep behavior disorder

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Class of Evidence: NPub.org/coe

  • CME Course: NPub.org/cmelist

  • Received July 18, 2019.
  • Accepted in final form January 27, 2020.
  • © 2020 American Academy of Neurology
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