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December 27, 2005; 65 (12) Views & Reviews

Diagnosis and management of dementia with Lewy bodies

Third report of the DLB consortium

I. G. McKeith, D. W. Dickson, J. Lowe, M. Emre, J. T. O'Brien, H. Feldman, J. Cummings, J. E. Duda, C. Lippa, E. K. Perry, D. Aarsland, H. Arai, C. G. Ballard, B. Boeve, D. J. Burn, D. Costa, T. Del Ser, B. Dubois, D. Galasko, S. Gauthier, C. G. Goetz, E. Gomez-Tortosa, G. Halliday, L. A. Hansen, J. Hardy, T. Iwatsubo, R. N. Kalaria, D. Kaufer, R. A. Kenny, A. Korczyn, K. Kosaka, V.M.Y. Lee, A. Lees, I. Litvan, E. Londos, O. L. Lopez, S. Minoshima, Y. Mizuno, J. A. Molina, E. B. Mukaetova-Ladinska, F. Pasquier, R. H. Perry, J. B. Schulz, J. Q. Trojanowski, M. Yamada
First published October 19, 2005, DOI: https://doi.org/10.1212/01.wnl.0000187889.17253.b1
I. G. McKeith
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M. Yamada
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Citation
Diagnosis and management of dementia with Lewy bodies
Third report of the DLB consortium
I. G. McKeith, D. W. Dickson, J. Lowe, M. Emre, J. T. O'Brien, H. Feldman, J. Cummings, J. E. Duda, C. Lippa, E. K. Perry, D. Aarsland, H. Arai, C. G. Ballard, B. Boeve, D. J. Burn, D. Costa, T. Del Ser, B. Dubois, D. Galasko, S. Gauthier, C. G. Goetz, E. Gomez-Tortosa, G. Halliday, L. A. Hansen, J. Hardy, T. Iwatsubo, R. N. Kalaria, D. Kaufer, R. A. Kenny, A. Korczyn, K. Kosaka, V.M.Y. Lee, A. Lees, I. Litvan, E. Londos, O. L. Lopez, S. Minoshima, Y. Mizuno, J. A. Molina, E. B. Mukaetova-Ladinska, F. Pasquier, R. H. Perry, J. B. Schulz, J. Q. Trojanowski, M. Yamada
Neurology Dec 2005, 65 (12) 1863-1872; DOI: 10.1212/01.wnl.0000187889.17253.b1

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Abstract

The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced striatal dopamine transporter activity on functional neuroimaging are given greater diagnostic weighting as features suggestive of a DLB diagnosis. The 1-year rule distinguishing between DLB and Parkinson disease with dementia may be difficult to apply in clinical settings and in such cases the term most appropriate to each individual patient should be used. Generic terms such as Lewy body (LB) disease are often helpful. The authors propose a new scheme for the pathologic assessment of LBs and Lewy neurites (LN) using alpha-synuclein immunohistochemistry and semiquantitative grading of lesion density, with the pattern of regional involvement being more important than total LB count. The new criteria take into account both Lewy-related and Alzheimer disease (AD)-type pathology to allocate a probability that these are associated with the clinical DLB syndrome. Finally, the authors suggest patient management guidelines including the need for accurate diagnosis, a target symptom approach, and use of appropriate outcome measures. There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in ∼50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.

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Letters: Rapid online correspondence

  • Reply from the Authors
    • Ian G. McKeith, University of Newcastle upon Tyne, Wlofson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, NE46BE, UKi.g.mckeith@ncl.ac.uk
    Submitted December 22, 2005
  • Diagnosis and management of dementia with Lewy bodies. Third report of the DLB consortium
    • Laura Bonanni, Dept. of Oncology and Neuroscience, University Chieti-Pescara, Neurophysiopathology, via Fonte Romana, 65124 Pescara, Italyl.bonanni@unich.it
    • Astrid Thomas, Marco Onofrj
    Submitted December 22, 2005
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