Reader response: Fourth consensus report of the DLB Consortium
GangWang, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China[email protected]
Hai-lun Cui, Shanghai, China; Yue Huang, Sydney, Australia
Submitted August 21, 2017
McKeith et al. [1] revised dementia with Lewy bodies (DLB) criteria with new developments
and statistics gathered through updated studies. The series of recommendations are in
perfect accordance with clinical settings (eg, the exclusion of antipsychotics for acute
management of DLB symptoms). However, there could be more explanations on the following two
issues.
Visual hallucination was not specifically defined. The introduction of visual evoked potential would be helpful in differentiating varied types of visual symptoms, [2, 3] as well as REM sleep behavior disorder, since both are outlined as core features of DLB presentations. Furthermore, the reaction of patients towards the contents of their visual hallucinations was not mentioned.
The application of a 1-year rule between the onset of dementia and parkinsonism mentioned in the revised criteria is not only used in research studies, but in clinical settings as well. Its application is particularly useful when neuropathologic evidence is not available; however, it is possible that the outcome of pathologic confirmed cases may not be accordance with what has been clinically diagnosed under the 1-year rule guidance in certain circumstances. Further investigations may be needed.
1. McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia
with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2017;89:88-100.
2. Armstrong R, Kergoat H. Oculo-visual changes and clinical considerations
affecting older patients with dementia. Ophthalmic Physiol Opt 2015;35:352-376.
3. Wang G, Wan Y, Wang Y, et al. Visual hallucinations and associated factors in
Chinese patients with Parkinson's disease: roles of RBD and visual pathway deficit.
Parkinsonism Relat Disord 2010;16:695-696.
For disclosures, please contact the editorial office at [email protected].
McKeith et al. [1] revised dementia with Lewy bodies (DLB) criteria with new developments and statistics gathered through updated studies. The series of recommendations are in perfect accordance with clinical settings (eg, the exclusion of antipsychotics for acute management of DLB symptoms). However, there could be more explanations on the following two issues.
Visual hallucination was not specifically defined. The introduction of visual evoked potential would be helpful in differentiating varied types of visual symptoms, [2, 3] as well as REM sleep behavior disorder, since both are outlined as core features of DLB presentations. Furthermore, the reaction of patients towards the contents of their visual hallucinations was not mentioned.
The application of a 1-year rule between the onset of dementia and parkinsonism mentioned in the revised criteria is not only used in research studies, but in clinical settings as well. Its application is particularly useful when neuropathologic evidence is not available; however, it is possible that the outcome of pathologic confirmed cases may not be accordance with what has been clinically diagnosed under the 1-year rule guidance in certain circumstances. Further investigations may be needed.
1. McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2017;89:88-100.
2. Armstrong R, Kergoat H. Oculo-visual changes and clinical considerations affecting older patients with dementia. Ophthalmic Physiol Opt 2015;35:352-376.
3. Wang G, Wan Y, Wang Y, et al. Visual hallucinations and associated factors in Chinese patients with Parkinson's disease: roles of RBD and visual pathway deficit. Parkinsonism Relat Disord 2010;16:695-696.
For disclosures, please contact the editorial office at [email protected].