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 features | Supportive clinical features |
|---|---|
| Fluctuating cognition | Severe sensitivity to antipsychotics |
| Recurrent visual hallucinations | Non-visual hallucinations |
| REM sleep behaviour disorder | Hypersomnia, hyposmia, delusions, apathy, anxiety, depression |
| ≥1 cardinal feature of Parkinsonism | Postural 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.