Diagnosis and management of dementia with Lewy bodies

Ian Grant McKeith, Bradley F. Boeve, Dennis W. Dickson, Glenda Margaret Halliday, John‐Paul Taylor, Daniel A. Weintraub, Dag Aarsland, James E. Galvin, Johannes Attems, Clive G. Ballard, Ashley Bayston, Thomas G. Beach, ‪Frederic Blanc‬, Nicolaas I. Bohnen, Laura Bonanni, José Brás, Patrik Brundin, David John Burn, Alice S. Chen‐Plotkin, John E. Duda, Omar M. A. El‐Agnaf, Howard Feldman, Tanis J. Ferman, Dominic H Ffytche, Hiroshige Fujishiro, Douglas R Galasko, Jennifer G. Goldman, Stephen N. Gomperts, Neill R. Graff‐Radford, Lawrence S. Honig, Álex Iranzo, Kejal Kantarci, Daniel Kaufer, Walter A. Kukull, Virginia M.‐Y. Lee, James B. Leverenz, Simon J.G. Lewis, Carol Frances Lippa, Angela M. Lunde, Mario Masellis, Eliezer Masliah, Pamela J. McLean, Brit Mollenhauer, Thomas Jude Montine, Etsuro Mori, Melissa Erin Murray, John Tiernan O'Brien, Sotoshi Orimo, Ronald B. Postuma, Shankar Ramaswamy, Owen A. Ross, David P. Salmon, Andrew B. Singleton, Angela Taylor, Alan J. Thomas, Pietro Tiraboschi, Jon B. Toledo, John Q. Trojanowski, Debby W. Tsuang, Zuzana Walker, Masahito Yamada, Kenji Kosaka

Neurology · 2017 · 4,591 citationsOpen access

doi.org/10.1212/wnl.0000000000004058 Free full text

Abstract

The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.

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McKeith, I. G., Boeve, B. F., Dickson, D. W., Halliday, G. M., Taylor, J., Weintraub, D. A., Aarsland, D., Galvin, J. E., Attems, J., Ballard, C. G., Bayston, A., Beach, T. G., Blanc‬, ‪Frederic, Bohnen, N. I., Bonanni, L., Brás, J., Brundin, P., Burn, D. J., Chen‐Plotkin, A. S., … Kosaka, K. (2017). Diagnosis and management of dementia with lewy bodies. Neurology, 89(1), 88–100. https://doi.org/10.1212/wnl.0000000000004058

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