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How to diagnose dementia with Lewy bodies: state of the art.
Mov Disord. 2005 Aug; 20 Suppl 12:S11-20.MD

Abstract

Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in older people that has only been recognized in the past decade and that remains widely underdiagnosed. At postmortem examination, affected patients show numerous alpha-synuclein-positive Lewy bodies (LB) in many parts of the cerebral cortex, particularly neocortical and limbic areas in addition to the nigral LB degeneration characteristic of Parkinson's disease (PD). Clinical presentation, unlike PD, is with progressive cognitive decline with particular deficits of visuospatial ability as well as frontal executive function accompanied by usually only mildly to moderately severe parkinsonism, which is often akineto-rigid without the classical parkinsonian rest-tremor. Further accompanying features include spontaneous recurrent visual hallucinations and conspicuous fluctuations in alertness and cognitive performance. The two main differential diagnoses are Alzheimer's disease (AD) and Parkinson's disease dementia (PDD). To improve the differential diagnosis of DLB, consensus criteria have been developed that establish possible and probable levels of clinical diagnostic accuracy. Generally, their sensitivity is variable and low but their specificity is high. Current consensus is to restrict a diagnosis of DLB only to patients with parkinsonism who develop dementia within 12 months of the onset of motor symptoms. Using operationalized criteria, DLB can be diagnosed clinically with an accuracy similar to that achieved for AD or PD. Ancillary investigations, particularly neuroimaging, can aid in differential diagnosis. We review the present state of the best practice in the clinical diagnosis of DLB. Future modifications of diagnostic criteria would ideally include the full range of clinical presentations that can be associated with LB disease.

Authors+Show Affiliations

Clinical Department of Neurology, Medical University Innsbruck, Austria. felix.geser@uibk.ac.atNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16092075

Citation

Geser, Felix, et al. "How to Diagnose Dementia With Lewy Bodies: State of the Art." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 20 Suppl 12, 2005, pp. S11-20.
Geser F, Wenning GK, Poewe W, et al. How to diagnose dementia with Lewy bodies: state of the art. Mov Disord. 2005;20 Suppl 12:S11-20.
Geser, F., Wenning, G. K., Poewe, W., & McKeith, I. (2005). How to diagnose dementia with Lewy bodies: state of the art. Movement Disorders : Official Journal of the Movement Disorder Society, 20 Suppl 12, S11-20.
Geser F, et al. How to Diagnose Dementia With Lewy Bodies: State of the Art. Mov Disord. 2005;20 Suppl 12:S11-20. PubMed PMID: 16092075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How to diagnose dementia with Lewy bodies: state of the art. AU - Geser,Felix, AU - Wenning,Gregor K, AU - Poewe,Werner, AU - McKeith,Ian, PY - 2005/8/11/pubmed PY - 2005/12/15/medline PY - 2005/8/11/entrez SP - S11 EP - 20 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 20 Suppl 12 N2 - Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in older people that has only been recognized in the past decade and that remains widely underdiagnosed. At postmortem examination, affected patients show numerous alpha-synuclein-positive Lewy bodies (LB) in many parts of the cerebral cortex, particularly neocortical and limbic areas in addition to the nigral LB degeneration characteristic of Parkinson's disease (PD). Clinical presentation, unlike PD, is with progressive cognitive decline with particular deficits of visuospatial ability as well as frontal executive function accompanied by usually only mildly to moderately severe parkinsonism, which is often akineto-rigid without the classical parkinsonian rest-tremor. Further accompanying features include spontaneous recurrent visual hallucinations and conspicuous fluctuations in alertness and cognitive performance. The two main differential diagnoses are Alzheimer's disease (AD) and Parkinson's disease dementia (PDD). To improve the differential diagnosis of DLB, consensus criteria have been developed that establish possible and probable levels of clinical diagnostic accuracy. Generally, their sensitivity is variable and low but their specificity is high. Current consensus is to restrict a diagnosis of DLB only to patients with parkinsonism who develop dementia within 12 months of the onset of motor symptoms. Using operationalized criteria, DLB can be diagnosed clinically with an accuracy similar to that achieved for AD or PD. Ancillary investigations, particularly neuroimaging, can aid in differential diagnosis. We review the present state of the best practice in the clinical diagnosis of DLB. Future modifications of diagnostic criteria would ideally include the full range of clinical presentations that can be associated with LB disease. SN - 0885-3185 UR - https://www.unboundmedicine.com/medline/citation/16092075/How_to_diagnose_dementia_with_Lewy_bodies:_state_of_the_art_ L2 - https://doi.org/10.1002/mds.20535 DB - PRIME DP - Unbound Medicine ER -