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Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.

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.

SUBMITTER: McKeith IG

PROVIDER: S-EPMC5496518 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.

McKeith Ian G IG Boeve Bradley F BF Dickson Dennis W DW Halliday Glenda G Taylor John-Paul JP Weintraub Daniel D Aarsland Dag D Galvin James J Attems Johannes J Ballard Clive G CG Bayston Ashley A Beach Thomas G TG Blanc Frédéric F Bohnen Nicolaas N Bonanni Laura L Bras Jose J Brundin Patrik P Burn David D Chen-Plotkin Alice A Duda John E JE El-Agnaf Omar O Feldman Howard H Ferman Tanis J TJ Ffytche Dominic D Fujishiro Hiroshige H Galasko Douglas D Goldman Jennifer G JG Gomperts Stephen N SN Graff-Radford Neill R NR Honig Lawrence S LS Iranzo Alex A Kantarci Kejal K Kaufer Daniel D Kukull Walter W Lee Virginia M Y VMY Leverenz James B JB Lewis Simon S Lippa Carol C Lunde Angela A Masellis Mario M Masliah Eliezer E McLean Pamela P Mollenhauer Brit B Montine Thomas J TJ Moreno Emilio E Mori Etsuro E Murray Melissa M O'Brien John T JT Orimo Sotoshi S Postuma Ronald B RB Ramaswamy Shankar S Ross Owen A OA Salmon David P DP Singleton Andrew A Taylor Angela A Thomas Alan A Tiraboschi Pietro P Toledo Jon B JB Trojanowski John Q JQ Tsuang Debby D Walker Zuzana Z Yamada Masahito M Kosaka Kenji K

Neurology 20170607 1

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 in ...[more]

PMID: 28592453

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Project description:ObjectiveDementia with Lewy bodies (DLB) is recognized as the second most common cause of degenerative dementia in older people with Alzheimer's disease (AD), and distinguishing between these 2 diseases may be challenging in clinical practice. However, accurate differentiation is important because these 2 diseases have different prognoses and require different care. Recently, several studies have reported that neuromelanin-sensitive MRI can detect neurodegeneration in the substantia nigra pars compacta (SNc). DLB patients are considered to demonstrate degeneration and a reduction of dopaminergic neurons in the SNc. Therefore, neuromelanin-sensitive MRI may be useful for the diagnosis of DLB. Therefore, in this study, we aimed to investigate the usefulness of neuromelanin-sensitive MRI in the distinguishing DLB from AD.MethodsA total of 21 probable DLB and 22 probable AD patients were enrolled. All participants underwent both DaT-SPECT and neuromelanin-sensitive MRI. A combined model of neuromelanin-sensitive MRI and Dopamine transporter single-photon emission computed tomography (DaT-SPECT) was created using logistic regression analysis (forced entry method).ResultsThere was no difference in the diagnostic utility of neuromelanin-sensitive MRI and DaT-SPECT in distinguishing DLB from AD. There was no significant correlation between the results of neuromelanin-sensitive MRI and DaT-SPECT in DLB patients. The combination of neuromelanin-sensitive MRI and DaT-SPECT demonstrated higher diagnostic performance in distinguishing between DLB and AD compared with neuromelanin-sensitive MRI alone. Additionally, although the combination of both modalities showed a larger AUC compared with DaT-SPECT alone, the difference was not statistically significant.ConclusionsNeuromelanin-sensitive MRI may be equally or even more useful than DaT-SPECT in the clinical differentiation of DLB from AD. Furthermore, the combination of neuromelanin-sensitive MRI and DaT-SPECT may be a highly sensitive imaging marker for distinguishing DLB from AD.

Dataset Information

Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.

Publications

Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.

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