Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies

Zande, Jessica J. van der; Gouw, Alida A.; Steenoven, Inger van; Beek, Marleen van de; Scheltens, Philip; Stam, Cornelis J.; Lemstra, Afina W.

doi:10.1212/wnl.0000000000009977

Cited by 36 publications

(46 citation statements)

References 37 publications

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“…Quantitative EEG findings of MCI-LB have been reported to be similar to those reported in DLB vs. AD, where MCI-LB have lower dominant frequency compared to MCI-AD [65][66][67]. This also translates into higher pre-alpha power and lower alpha and beta power and a higher theta/alpha ratio [65][66][67].…”

Section: Prodromal Dlb and Progression To Dementiasupporting

confidence: 59%

“…AD, where MCI-LB have lower dominant frequency compared to MCI-AD [ 65 , 66 , 67 ]. This also translates into higher pre-alpha power and lower alpha and beta power and a higher theta/alpha ratio [ 65 , 66 , 67 ]. Schumacher 2020b reported that spectral power analyses had sensitivities of 23–51%, specificity of 81–97% and area under receiver operating characteristics curve (AUROC) of 0.54–0.71 in diagnosing MCI-LB ( Table 4 ) [ 67 ].…”

Section: Resultsmentioning

confidence: 99%

“…Thus, potentially at the prodromal stage, EEG may be comparable to dopaminergic imaging which had a sensitivity of 61% and specificity of 89% in diagnosing MCI-LB [75]. In addition, EEG features including CSA pattern >1, diffuse slowing, EEG severity grade and alpha-2 power were predictive of progression to dementia [36,66]. However, given the small number of studies performed to date, variable accuracy performance, as well as lack of clarity on what is the optimal EEG spectral feature(s) for diagnostic separation, further validation studies in prodromal DLB groups are needed.…”

Section: Discussionmentioning

confidence: 99%

“…EEG abnormalities on visual rating have been reported to be more common in DLB even at the mild cognitive impairment (MCI) stage. Comparing MCI with Lewy bodies (MCI-LB) and MCI due to AD (MCI-AD), diffuse abnormalities (76% vs. 8%) and FIRDA (22% vs. 0%) were more common in MCI-LB [66]. EEG severity scores were significantly worse in MCI-LB as well, where only 16% of MCI-LB had normal EEG while EEGs were normal in 49% of MCI-AD [66].…”

Section: Prodromal Dlb and Progression To Dementiamentioning

confidence: 99%

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The Role of EEG in the Diagnosis, Prognosis and Clinical Correlations of Dementia with Lewy Bodies—A Systematic Review

et al. 2020

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Despite improvements in diagnostic criteria for dementia with Lewy bodies (DLB), the ability to discriminate DLB from Alzheimer’s disease (AD) and other dementias remains suboptimal. Electroencephalography (EEG) is currently a supportive biomarker in the diagnosis of DLB. We performed a systematic review to better clarify the diagnostic and prognostic role of EEG in DLB and define the clinical correlates of various EEG features described in DLB. MEDLINE, EMBASE, and PsycINFO were searched using search strategies for relevant articles up to 6 August 2020. We included 43 studies comparing EEG in DLB with other diagnoses, 42 of them included a comparison of DLB with AD, 10 studies compared DLB with Parkinson’s disease dementia, and 6 studies compared DLB with other dementias. The studies were visual EEG assessment (6), quantitative EEG (35) and event-related potential studies (2). The most consistent observation was the slowing of the dominant EEG rhythm (<8 Hz) assessed visually or through quantitative EEG, which was observed in ~90% of patients with DLB and only ~10% of patients with AD. Other findings based on qualitative rating, spectral power analyses, connectivity, microstate and machine learning algorithms were largely heterogenous due to differences in study design, EEG acquisition, preprocessing and analysis. EEG protocols should be standardized to allow replication and validation of promising EEG features as potential biomarkers in DLB.

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Section: Prodromal Dlb and Progression To Dementiasupporting

confidence: 59%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Prodromal Dlb and Progression To Dementiamentioning

confidence: 99%

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The Role of EEG in the Diagnosis, Prognosis and Clinical Correlations of Dementia with Lewy Bodies—A Systematic Review

et al. 2020

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“…Quantitative or visually assessed EEG differentiates DLB from AD with high sensitivity and specificity and may correlate with cognitive changes, fluctuations, and hallucinations in DLB [ 62 , 63 ]. EEG also may have a role not only in diagnosing MCI-LB, with slower frequencies in pre-alpha and theta ranges compared to healthy controls and intermittent delta activity patterns differentiating MCI-LB from MCI-AD, but also in predicting conversion from MCI-LB to DLB [ 64 , 65 ]. While potentially less costly and less invasive than some biomarker studies, use of EEG as a diagnostic or prognostic biomarker for LBD will require increased standardization, understanding of inter-individual variability, integration with imaging and biofluid markers, and larger-scale prospective studies.…”

Section: Optimizing Clinical Trial Design In Lbd (Table 2 mentioning

confidence: 99%

Challenges and opportunities for improving the landscape for Lewy body dementia clinical trials

et al. 2020

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Lewy body dementia (LBD), including dementia with Lewy bodies and Parkinson’s disease dementia, affects over a million people in the USA and has a substantial impact on patients, caregivers, and society. Symptomatic treatments for LBD, which can include cognitive, neuropsychiatric, autonomic, sleep, and motor features, are limited with only two drugs (cholinesterase inhibitors) currently approved by regulatory agencies for dementia in LBD. Clinical trials represent a top research priority, but there are many challenges in the development and implementation of trials in LBD. To address these issues and advance the field of clinical trials in the LBDs, the Lewy Body Dementia Association formed an Industry Advisory Council (LBDA IAC), in addition to its Research Center of Excellence program. The LBDA IAC comprises a diverse and collaborative group of experts from academic medical centers, pharmaceutical industries, and the patient advocacy foundation. The inaugural LBDA IAC meeting, held in June 2019, aimed to bring together this group, along with representatives from regulatory agencies, to address the topic of optimizing the landscape of LBD clinical trials. This review highlights the formation of the LBDA IAC, current state of LBD clinical trials, and challenges and opportunities in the field regarding trial design, study populations, diagnostic criteria, and biomarker utilization. Current gaps include a lack of standardized clinical assessment tools and evidence-based management strategies for LBD as well as difficulty and controversy in diagnosing LBD. Challenges in LBD clinical trials include the heterogeneity of LBD pathology and symptomatology, limited understanding of the trajectory of LBD cognitive and core features, absence of LBD-specific outcome measures, and lack of established standardized biologic, imaging, or genetic biomarkers that may inform study design. Demands of study participation (e.g., travel, duration, and frequency of study visits) may also pose challenges and impact trial enrollment, retention, and outcomes. There are opportunities to improve the landscape of LBD clinical trials by harmonizing clinical assessments and biomarkers across cohorts and research studies, developing and validating outcome measures in LBD, engaging the patient community to assess research needs and priorities, and incorporating biomarker and genotype profiling in study design.

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Research diagnostic criteria for mild cognitive impairment with Lewy bodies: A systematic review and meta‐analysis

Donaghy

Carrarini

Ferreira

et al. 2023

Alzheimer's & Dementia

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Introduction Operationalized research criteria for mild cognitive impairment with Lewy bodies (MCI‐LB) were published in 2020. The aim of this systematic review and meta‐analysis was to review the evidence for the diagnostic clinical features and biomarkers in MCI‐LB set out in the criteria. Methods MEDLINE, PubMed, and Embase were searched on 9/28/22 for relevant articles. Articles were included if they presented original data reporting the rates of diagnostic features in MCI‐LB. Results Fifty‐seven articles were included. The meta‐analysis supported the inclusion of the current clinical features in the diagnostic criteria. Evidence for striatal dopaminergic imaging and meta‐iodobenzylguanidine cardiac scintigraphy, though limited, supports their inclusion. Quantitative electroencephalogram (EEG) and fluorodeoxyglucose positron emission tomography (PET) show promise as diagnostic biomarkers. Discussion The available evidence largely supports the current diagnostic criteria for MCI‐LB. Further evidence will help refine the diagnostic criteria and understand how best to apply them in clinical practice and research. Highlights A meta‐analysis of the diagnostic features of MCI‐LB was carried out. The four core clinical features were more common in MCI‐LB than MCI‐AD/stable MCI. Neuropsychiatric and autonomic features were also more common in MCI‐LB. More evidence is needed for the proposed biomarkers. FDG‐PET and quantitative EEG show promise as diagnostic biomarkers in MCI‐LB.

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Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies

Cited by 36 publications

References 37 publications

The Role of EEG in the Diagnosis, Prognosis and Clinical Correlations of Dementia with Lewy Bodies—A Systematic Review

The Role of EEG in the Diagnosis, Prognosis and Clinical Correlations of Dementia with Lewy Bodies—A Systematic Review

Challenges and opportunities for improving the landscape for Lewy body dementia clinical trials

Research diagnostic criteria for mild cognitive impairment with Lewy bodies: A systematic review and meta‐analysis

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