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The Impact of Lewy Body Co-Pathology in Amnestic Patients: Featured Publication in Brain
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Jesús Silva-Rodríguez, coordinator of the Neuroimaging Platform at the Center for Research on Neurological Diseases (CIEN), leads a study recently published in the prestigious journal Brain, selected as Editor’s Choice, analyzing the effect of Lewy body (LB) co-pathology on the clinical and neuroimaging phenotype of patients with amnestic impairment.
The article, titled “The effect of Lewy body (co-)pathology on the clinical and imaging phenotype of amnestic patients” (Brain, July 2025), examines 865 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort diagnosed with amnestic mild cognitive impairment or Alzheimer’s disease dementia. By combining cerebrospinal fluid (CSF) biomarkers, FDG-PET imaging, and longitudinal clinical data, the authors classified participants according to the presence of Alzheimer’s disease and/or Lewy body pathology, evaluating how these combinations influence clinical progression, cognitive profiles, and patterns of cerebral hypometabolism.
Key findings of the study:
- Patients with both Alzheimer’s and Lewy body pathology (AD+LB+) experienced more severe and faster global cognitive decline, though their clinical profile remained memory-predominant, similar to those with Alzheimer’s alone (AD+LB−).
- Cases with only Lewy body pathology (AD−LB+) showed a predominantly executive/visuospatial cognitive profile and a distinct posterior-occipital pattern of hypometabolism, characteristic of Lewy body disease.
- The presence of Lewy body pathology without Alzheimer’s disease biomarkers was associated with a higher risk of developing hallucinations, especially in those with posterior-occipital hypometabolism.
This research underscores the importance of identifying co-pathologies in patients with amnestic syndromes, as they can significantly alter the clinical course and complicate diagnosis.
The significance of this study is further highlighted by the accompanying editorial in the same Brain issue, authored by Dr. Rimona S. Weil, titled “Seeing the trees in the wood: the importance of co-pathologies in Alzheimer’s disease and dementia with Lewy bodies.” Dr. Weil emphasizes how recent advances in biomarker technology now allow for the in vivo detection of co-pathologies, blurring traditional diagnostic boundaries and opening the door to personalized treatments based on specific pathological profiles.
Article reference:
Accompanying editorial:
Weil, R.S. (2025). Seeing the trees in the wood: the importance of co-pathologies in Alzheimer’s disease and dementia with Lewy bodies. Brain, 148(7), 2233–2234. https://doi.org/10.1093/brain/awaf197