Table 2.

Diagnosis of dementia with Lewy bodies. Probable dementia with Lewy bodies can be diagnosed with ≥2 core clinical features, or one core clinical feature and ≥1 indicative biomarker. Possible dementia with Lewy bodies can be diagnosed with only one core clinical feature or ≥1 indicative biomarker without a core clinical feature. Adapted with permission from McKeith IG, Boeve BF, Dickson DW et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2017;89:88–100.

Core clinical featuresSupportive clinical features
Fluctuating cognitionSevere sensitivity to antipsychotics
Recurrent visual hallucinationsNon-visual hallucinations
REM sleep behaviour disorderHypersomnia, hyposmia, delusions, apathy, anxiety, depression
≥1 cardinal feature of ParkinsonismPostural instability
Episodes of unresponsiveness
Indicative biomarkers Supportive biomarkers
Reduced dopamine transporter uptake in basal ganglia (by SPECT or PET)Relative preservation of medial temporal lobe (by CT/MRI)
Abnormal 123iodine-MIBG myocardial scintigraphy (low uptake)Generalised low uptake perfusion/metabolism scan with reduced occipital activity (by SPECT/PET)
+/- the cingulate island sign (by FDG-PET)
REM sleep without atonia (polysomnographic confirmation)Prominent posterior slow-wave activity with periodic fluctuations in the pre-alpha/theta range (by EEG)
  • MIBG = metaiodobenzylguanidine; CT = computed tomography; EEG = electroencephalography; FDG-PET = fluorodeoxyglucose-positron emission tomography; MRI = magnetic resonance imaging; PET = positron emission tomography; REM = rapid eye movoement; SPECT = single-photon-emission computed tomography.