Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium

I. G. McKeith, Dennis W Dickson, J. Lowe, M. Emre, J. T. O'Brien, H. Feldman, J. Cummings, J. E. Duda, C. Lippa, E. K. Perry, D. Aarsland, H. Arai, C. G. Ballard, Bradley F Boeve, D. J. Burn, D. Costa, T. Del Ser, B. Dubois, D. Galasko, S. GauthierC. G. Goetz, E. Gomez-Tortosa, G. Halliday, L. A. Hansen, J. Hardy, T. Iwatsubo, R. N. Kalaria, D. Kaufer, R. A. Kenny, A. Korczyn, K. Kosaka, V. M Y Lee, A. Lees, I. Litvan, E. Londos, O. L. Lopez, S. Minoshima, Y. Mizuno, J. A. Molina, E. B. Mukaetova-Ladinska, F. Pasquier, R. H. Perry, J. B. Schulz, J. Q. Trojanowski, M. Yamada

Research output: Contribution to journalArticle

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Abstract

The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced striatal dopamine transporter activity on functional neuroimaging are given greater diagnostic weighting as features suggestive of a DLB diagnosis. The 1-year rule distinguishing between DLB and Parkinson disease with dementia may be difficult to apply in clinical settings and in such cases the term most appropriate to each individual patient should be used. Generic terms such as Lewy body (LB) disease are often helpful. The authors propose a new scheme for the pathologic assessment of LBs and Lewy neurites (LN) using alpha-synuclein immunohistochemistry and semiquantitative grading of lesion density, with the pattern of regional involvement being more important than total LB count. The new criteria take into account both Lewy-related and Alzheimer disease (AD)-type pathology to allocate a probability that these are associated with the clinical DLB syndrome. Finally, the authors suggest patient management guidelines including the need for accurate diagnosis, a target symptom approach, and use of appropriate outcome measures. There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in ∼50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.

Original languageEnglish (US)
Pages (from-to)1863-1872
Number of pages10
JournalNeurology
Volume65
Issue number12
DOIs
StatePublished - Dec 2005

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Lewy Body Disease
Antipsychotic Agents
Dementia
REM Sleep Behavior Disorder
Lewy Bodies
Corpus Striatum
alpha-Synuclein
Dopamine Plasma Membrane Transport Proteins
Functional Neuroimaging
Hallucinations
Vision Disorders
Cholinesterase Inhibitors
Levodopa
Neurites
Parkinson Disease
Alzheimer Disease
Immunohistochemistry
Outcome Assessment (Health Care)
Guidelines
Pathology

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

McKeith, I. G., Dickson, D. W., Lowe, J., Emre, M., O'Brien, J. T., Feldman, H., ... Yamada, M. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology, 65(12), 1863-1872. https://doi.org/10.1212/01.wnl.0000187889.17253.b1

Diagnosis and management of dementia with Lewy bodies : Third report of the DLB consortium. / McKeith, I. G.; Dickson, Dennis W; Lowe, J.; Emre, M.; O'Brien, J. T.; Feldman, H.; Cummings, J.; Duda, J. E.; Lippa, C.; Perry, E. K.; Aarsland, D.; Arai, H.; Ballard, C. G.; Boeve, Bradley F; Burn, D. J.; Costa, D.; Del Ser, T.; Dubois, B.; Galasko, D.; Gauthier, S.; Goetz, C. G.; Gomez-Tortosa, E.; Halliday, G.; Hansen, L. A.; Hardy, J.; Iwatsubo, T.; Kalaria, R. N.; Kaufer, D.; Kenny, R. A.; Korczyn, A.; Kosaka, K.; Lee, V. M Y; Lees, A.; Litvan, I.; Londos, E.; Lopez, O. L.; Minoshima, S.; Mizuno, Y.; Molina, J. A.; Mukaetova-Ladinska, E. B.; Pasquier, F.; Perry, R. H.; Schulz, J. B.; Trojanowski, J. Q.; Yamada, M.

In: Neurology, Vol. 65, No. 12, 12.2005, p. 1863-1872.

Research output: Contribution to journalArticle

McKeith, IG, Dickson, DW, Lowe, J, Emre, M, O'Brien, JT, Feldman, H, Cummings, J, Duda, JE, Lippa, C, Perry, EK, Aarsland, D, Arai, H, Ballard, CG, Boeve, BF, Burn, DJ, Costa, D, Del Ser, T, Dubois, B, Galasko, D, Gauthier, S, Goetz, CG, Gomez-Tortosa, E, Halliday, G, Hansen, LA, Hardy, J, Iwatsubo, T, Kalaria, RN, Kaufer, D, Kenny, RA, Korczyn, A, Kosaka, K, Lee, VMY, Lees, A, Litvan, I, Londos, E, Lopez, OL, Minoshima, S, Mizuno, Y, Molina, JA, Mukaetova-Ladinska, EB, Pasquier, F, Perry, RH, Schulz, JB, Trojanowski, JQ & Yamada, M 2005, 'Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium', Neurology, vol. 65, no. 12, pp. 1863-1872. https://doi.org/10.1212/01.wnl.0000187889.17253.b1
McKeith, I. G. ; Dickson, Dennis W ; Lowe, J. ; Emre, M. ; O'Brien, J. T. ; Feldman, H. ; Cummings, J. ; Duda, J. E. ; Lippa, C. ; Perry, E. K. ; Aarsland, D. ; Arai, H. ; Ballard, C. G. ; Boeve, Bradley F ; Burn, D. J. ; Costa, D. ; Del Ser, T. ; Dubois, B. ; Galasko, D. ; Gauthier, S. ; Goetz, C. G. ; Gomez-Tortosa, E. ; Halliday, G. ; Hansen, L. A. ; Hardy, J. ; Iwatsubo, T. ; Kalaria, R. N. ; Kaufer, D. ; Kenny, R. A. ; Korczyn, A. ; Kosaka, K. ; Lee, V. M Y ; Lees, A. ; Litvan, I. ; Londos, E. ; Lopez, O. L. ; Minoshima, S. ; Mizuno, Y. ; Molina, J. A. ; Mukaetova-Ladinska, E. B. ; Pasquier, F. ; Perry, R. H. ; Schulz, J. B. ; Trojanowski, J. Q. ; Yamada, M. / Diagnosis and management of dementia with Lewy bodies : Third report of the DLB consortium. In: Neurology. 2005 ; Vol. 65, No. 12. pp. 1863-1872.
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AU - McKeith, I. G.

AU - Dickson, Dennis W

AU - Lowe, J.

AU - Emre, M.

AU - O'Brien, J. T.

AU - Feldman, H.

AU - Cummings, J.

AU - Duda, J. E.

AU - Lippa, C.

AU - Perry, E. K.

AU - Aarsland, D.

AU - Arai, H.

AU - Ballard, C. G.

AU - Boeve, Bradley F

AU - Burn, D. J.

AU - Costa, D.

AU - Del Ser, T.

AU - Dubois, B.

AU - Galasko, D.

AU - Gauthier, S.

AU - Goetz, C. G.

AU - Gomez-Tortosa, E.

AU - Halliday, G.

AU - Hansen, L. A.

AU - Hardy, J.

AU - Iwatsubo, T.

AU - Kalaria, R. N.

AU - Kaufer, D.

AU - Kenny, R. A.

AU - Korczyn, A.

AU - Kosaka, K.

AU - Lee, V. M Y

AU - Lees, A.

AU - Litvan, I.

AU - Londos, E.

AU - Lopez, O. L.

AU - Minoshima, S.

AU - Mizuno, Y.

AU - Molina, J. A.

AU - Mukaetova-Ladinska, E. B.

AU - Pasquier, F.

AU - Perry, R. H.

AU - Schulz, J. B.

AU - Trojanowski, J. Q.

AU - Yamada, M.

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