Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies

Abstract

Objective: To determine whether adding REM sleep behavior disorder (RBD) to the dementia with Lewy bodies (DLB) diagnostic criteria improves classification accuracy of autopsy-confirmed DLB. Methods:We followed 234 consecutive patients with dementia until autopsy with a mean of 4 annual visits. Clinical diagnoses included DLB, Alzheimer disease (AD), corticobasal syndrome, and frontotemporal dementia. Pathologic diagnoses used the 2005 DLB consensus criteria and included no/low likelihood DLB (non-DLB; n ϭ 136) and intermediate/high likelihood DLB (DLB; n ϭ 98). Regression modeling and sensitivity/specificity analyses were used to evaluate the diagnostic role of RBD.Results: Each of the 3 core features increased the odds of autopsy-confirmed DLB up to 2-fold, and RBD increased the odds by 6-fold. When clinically probable DLB reflected dementia and 2 or more of the 3 core features, sensitivity was 85%, and specificity was 73%. When RBD was added and clinically probable DLB reflected 2 or more of 4 features, sensitivity improved to 88%. When dementia and RBD were also designated as probable DLB, sensitivity increased to 90% while specificity remained at 73%. The VH, parkinsonism, RBD model lowered sensitivity to 83%, but improved specificity to 85%. Dementia with Lewy bodies (DLB) is considered the second most common cause of neurodegenerative disease after Alzheimer disease (AD), with an estimated prevalence of up to 30%. Conclusions: 1-3Validation of older versions of the DLB criteria tend to show high specificity at the expense of poor sensitivity, 4 -8 though more acceptable ranges are found with the use of standardized measures.9 It is critical to properly diagnose DLB during life in order to optimize symptom management, reduce iatrogenic treatment complications, and develop new therapies designed to prevent or interfere with disease progression.In 2005, the DLB diagnostic criteria were modified to include 3 new features in a category termed "suggestive features." With this revision, clinically probable DLB is represented by 2 or more core features (fluctuations, parkinsonism, or visual hallucinations), or by one core feature plus one suggestive feature. 10 The suggestive features include severe neuroleptic sensitivity, reducedFrom the Department of Psychiatry and Psychology (T

Risk factors for dementia with Lewy bodies

“…When cases were defined with more specific criteria 37 or by final diagnosis, the patterns of association were unchanged, except that alcohol use became statistically significant in the DLB vs control comparison (table e-2). In the DLB vs AD comparison, alcohol and caffeine reached statistical significance, but oophorectomy before age 45 lost significance, when the specific, but not final, diagnosis was used (table e-3).…”

Structural grey matter changes in the substantia innominata in Alzheimer's disease and dementia with Lewy bodies: a DARTEL‐VBM study

“…Firstly, despite following a previously reported protocol (Choi et al ., 2012; George et al ., 2011; Shin et al ., 2012), these findings should still be considered tentative, given the relatively small size, proximity and subsequent methodological challenges surrounding the automated GM segmentation of the SI and of similar structures from MR images. Secondly, there were no pathologically confirmed diagnoses, although the applied clinical diagnostic criteria were associated with high diagnostic specificity (Ferman et al ., 2011; Knopman et al ., 2001). Lastly, although the examination of a significant omnibus effect across groups, followed by appropriate post hoc tests, would have allowed a more systematic approach to the group analyses, this approach is potentially too conservative, and where focal changes between different types of dementia and healthy ageing are often relatively small, potentially important findings can be overlooked.…”

Nonamnestic mild cognitive impairment progresses to dementia with Lewy bodies

“…All participants underwent an annual neurocognitive evaluation to establish the presence or absence of formal cognitive impairment in one or more cognitive domains. 1,3 This included 10 tests to assess the following domains using Mayo age-adjusted norms [14][15][16][17][18] 25,26 Established diagnostic criteria for clinically probable AD, frontotemporal dementia, and MCI were used. 3,[27][28][29] Standard protocol approvals, registrations, and patient consents.…”

“…Subtle parkinsonism has also been reported in "idiopathic" RBD, which is associated with elevated predictive risk of DLB and PD. 26,37 This suggests that some core DLB clinical features may emerge before the cognitive and functional impairment constitutes a dementia syndrome.…”