The cognitive connectome in dementia with lewy bodies undergoes early alterations already at the mild cognitive impairment stage.

Cognitive impairment is required to diagnose mild cognitive impairment with Lewy bodies (MCI-LB). However, associations of impairments across cognitive domains remain unclear. In this cross-sectional study, we investigated these associations by assessing the cognitive connectome of MCI-LB patients compared with healthy controls (HC), mild cognitive impairment due to Alzheimer's disease (MCI-AD), and dementia with Lewy bodies (DLB). Using the National Alzheimer's Coordinating Center database, we built cognitive connectomes for MCI-LB (n = 88), HC (n = 3703), MCI-AD (n = 1789), and DLB (n = 104) by correlating 24 cognitive measures. We compared global and nodal network measures of centrality (importance of cognitive measure), integration (communication across cognitive measures), and segregation (specialisation of cognitive measures) between groups. For global measures, MCI-LB showed lower segregation than HC, with no significant differences from MCI-AD, and lower integration) and higher segregation than DLB. For nodal measures, MCI-LB compared with HC and MCI-AD showed differences in executive and memory measures, respectively. MCI-LB showed several nodal differences compared with DLB, involving executive, processing speed/attention, and language measures. Our findings suggest that MCI-LB involves early changes in the cognitive connectome, particularly reduced segregation that becomes more pronounced at the DLB stage and shows overlap with MCI-AD, offering insights into cognitive impairment in MCI-LB.