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Diagnosis and management of dementia with Lewy bodies - Third report of the DLB consortium

McKeith, IG; Dickson, DW; Lowe, J; Emre, M; O'Brien, JT; Feldman, H; Cummings, J; Duda, JE; Lippa, C and Perry, EK, et al. (2005) In Neurology 65(12). p.1863-1872
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... (More)
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 similar to 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors. (Less)
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published
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Neurology
volume
65
issue
12
pages
1863 - 1872
publisher
American Academy of Neurology
external identifiers
  • pmid:16237129
  • wos:000234246400005
  • scopus:33144489150
ISSN
1526-632X
DOI
10.1212/01.wnl.0000187889.17253.b1
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English
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2de9ba8f-471e-41a9-9ba6-aff6deb87890 (old id 894203)
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2008-01-16 14:50:02
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@article{2de9ba8f-471e-41a9-9ba6-aff6deb87890,
  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 similar to 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.},
  author       = {McKeith, IG and Dickson, DW and Lowe, J and Emre, M and O'Brien, JT and Feldman, H and Cummings, J and Duda, JE and Lippa, C and Perry, EK and Aarsland, D and Arai, H and Ballard, CG and Boeve, B and Burn, DJ and Costa, D and Del Ser, T and Dubois, B and Galasko, D and Gauthier, S and Goetz, CG and Gomez-Tortosa, E and Halliday, G and Hansen, LA and Hardy, J and Iwatsubo, T and Kalaria, RN and Kaufer, D and Kenny, RA and Korczyn, A and Kosaka, K and Lee, VMY and Lees, A and Litvan, I and Londos, Elisabet and Lopez, OL and Minoshima, S and Mizuno, Y and Molina, JA and Mukaetova-Ladinska, EB and Pasquier, F and Perry, RH and Schulz, JB and Trojanowski, JQ and Yamada, M},
  issn         = {1526-632X},
  language     = {eng},
  number       = {12},
  pages        = {1863--1872},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Diagnosis and management of dementia with Lewy bodies - Third report of the DLB consortium},
  url          = {http://dx.doi.org/10.1212/01.wnl.0000187889.17253.b1},
  volume       = {65},
  year         = {2005},
}