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Dementia with Lewy bodies.
Semin Clin Neuropsychiatry. 2003 Jan; 8(1):46-57.SC

Abstract

The objective was to summarize recent findings about the clinical features, diagnosis and investigation of dementia with Lewy (DLB) bodies, together with its neuropathology, neurochemistry and genetics. Dementia with Lewy bodies (DLB) is a primary, neurodegenerative dementia sharing clinical and pathological characteristics with both Parkinson's disease (PD) and Alzheimer's disease (AD). Antiubiquitin immunocytochemical staining, developed in the early 1990s, allowed the frequency and distribution of cortical LBs to be defined. More recently, alpha-synuclein antibodies have revealed extensive neuritic pathology in DLB demonstrating a neurobiological link with other "synucleinopathies" including PD and multiple system atrophy (MSA). The most significant correlates of cognitive failure in DLB appear to be with cortical LB and Lewy neurites (LNs) rather than Alzheimer type pathology. Clinical diagnostic criteria for DLB, published in 1996, have been subjected to several validation studies against autopsy findings. These conclude that although diagnostic specificity is high (range 79- 100%, mean 92%), sensitivity is lower (range 0- 83 %, mean, 49%). Improved methods of case detection are therefore required. Fluctuating impairments in attention, visual recognition and construction are more indicative of DLB than AD. Relative preservation of medial temporal lobe volume on structural MRI and the use of SPECT tracers for regional blood flow and the dopamine transporter are the most reliable current biomarkers for DLB. There are no genetic or CSF tests recommended for the diagnosis of DLB at present. Between 15 and 20% of all elderly demented cases reaching autopsy have DLB, making it the most common cause of degenerative dementia after AD. Exquisite, not infrequently fatal, sensitivity to neuroleptic drugs and encouraging reports of the effects of cholinesterase inhibitors on cognitive, psychiatric and neurological features, mean that an accurate diagnosis of DLB is more than merely of academic interest. Dementia developing late in the course of PD shares many of the same clinical and pathological characteristics.

Authors+Show Affiliations

Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Newcastle, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12567332

Citation

McKeith, Ian G., et al. "Dementia With Lewy Bodies." Seminars in Clinical Neuropsychiatry, vol. 8, no. 1, 2003, pp. 46-57.
McKeith IG, Burn DJ, Ballard CG, et al. Dementia with Lewy bodies. Semin Clin Neuropsychiatry. 2003;8(1):46-57.
McKeith, I. G., Burn, D. J., Ballard, C. G., Collerton, D., Jaros, E., Morris, C. M., McLaren, A., Perry, E. K., Perry, R., Piggott, M. A., & O'Brien, J. T. (2003). Dementia with Lewy bodies. Seminars in Clinical Neuropsychiatry, 8(1), 46-57.
McKeith IG, et al. Dementia With Lewy Bodies. Semin Clin Neuropsychiatry. 2003;8(1):46-57. PubMed PMID: 12567332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dementia with Lewy bodies. AU - McKeith,Ian G, AU - Burn,David J, AU - Ballard,Clive G, AU - Collerton,Daniel, AU - Jaros,Evelyn, AU - Morris,Chris M, AU - McLaren,Andrew, AU - Perry,Elaine K, AU - Perry,Robert, AU - Piggott,Margaret A, AU - O'Brien,John T, PY - 2003/2/5/pubmed PY - 2003/4/18/medline PY - 2003/2/5/entrez SP - 46 EP - 57 JF - Seminars in clinical neuropsychiatry JO - Semin Clin Neuropsychiatry VL - 8 IS - 1 N2 - The objective was to summarize recent findings about the clinical features, diagnosis and investigation of dementia with Lewy (DLB) bodies, together with its neuropathology, neurochemistry and genetics. Dementia with Lewy bodies (DLB) is a primary, neurodegenerative dementia sharing clinical and pathological characteristics with both Parkinson's disease (PD) and Alzheimer's disease (AD). Antiubiquitin immunocytochemical staining, developed in the early 1990s, allowed the frequency and distribution of cortical LBs to be defined. More recently, alpha-synuclein antibodies have revealed extensive neuritic pathology in DLB demonstrating a neurobiological link with other "synucleinopathies" including PD and multiple system atrophy (MSA). The most significant correlates of cognitive failure in DLB appear to be with cortical LB and Lewy neurites (LNs) rather than Alzheimer type pathology. Clinical diagnostic criteria for DLB, published in 1996, have been subjected to several validation studies against autopsy findings. These conclude that although diagnostic specificity is high (range 79- 100%, mean 92%), sensitivity is lower (range 0- 83 %, mean, 49%). Improved methods of case detection are therefore required. Fluctuating impairments in attention, visual recognition and construction are more indicative of DLB than AD. Relative preservation of medial temporal lobe volume on structural MRI and the use of SPECT tracers for regional blood flow and the dopamine transporter are the most reliable current biomarkers for DLB. There are no genetic or CSF tests recommended for the diagnosis of DLB at present. Between 15 and 20% of all elderly demented cases reaching autopsy have DLB, making it the most common cause of degenerative dementia after AD. Exquisite, not infrequently fatal, sensitivity to neuroleptic drugs and encouraging reports of the effects of cholinesterase inhibitors on cognitive, psychiatric and neurological features, mean that an accurate diagnosis of DLB is more than merely of academic interest. Dementia developing late in the course of PD shares many of the same clinical and pathological characteristics. SN - 1084-3612 UR - https://www.unboundmedicine.com/medline/citation/12567332/Dementia_with_Lewy_bodies_ L2 - https://medlineplus.gov/lewybodydementia.html DB - PRIME DP - Unbound Medicine ER -