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

Research output: Contribution to journalArticle

Ian G. McKeith, Bradley F. Boeve, Dennis W. DIckson, Glenda Halliday, John Paul Taylor, Daniel Weintraub, Dag Aarsland, James Galvin, Johannes Attems, Clive G. Ballard, Ashley Bayston, Thomas G. Beach, Frédéric Blanc, Nicolaas Bohnen, Laura Bonanni, Jose Bras, Patrik Brundin, David Burn, Alice Chen-Plotkin, John E. Duda & 43 more Omar El-Agnaf, Howard Feldman, Tanis J. Ferman, Dominic Ffytche, Hiroshige Fujishiro, Douglas Galasko, Jennifer G. Goldman, Stephen N. Gomperts, Neill R. Graff-Radford, Lawrence S. Honig, Alex Iranzo, Kejal Kantarci, Daniel Kaufer, Walter Kukull, Virginia M.Y. Lee, James B. Leverenz, Simon Lewis, Carol Lippa, Angela Lunde, Mario Masellis, Eliezer Masliah, Pamela McLean, Brit Mollenhauer, Thomas J. Montine, Emilio Moreno, Etsuro Mori, Melissa Murray, John T. O'Brien, Sotoshi Orimo, Ronald B. Postuma, Shankar Ramaswamy, Owen A. Ross, David P. Salmon, Andrew Singleton, Angela Taylor, Alan Thomas, Pietro Tiraboschi, Jon B. Toledo, John Q. Trojanowski, Debby Tsuang, Zuzana Walker, Masahito Yamada, Kenji Kosaka

Original languageEnglish
Pages (from-to)88-100
Number of pages13
JournalNeurology
Volume89
Issue number1
Early online date7 Jul 2017
DOIs
Accepted/In press30 Mar 2017
E-pub ahead of print7 Jul 2017
Published2017

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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 123 iodine-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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