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

Tanis Jill Ferman, Bradley F Boeve, G. E. Smith, S. C. Lin, M. H. Silber, Otto D Pedraza, Zbigniew K Wszolek, Neill R Graff Radford, R. Uitti, Jay A Van Gerpen, W. Pao, David S Knopman, V. S. Pankratz, Kejal M Kantarci, B. Boot, Joseph E Parisi, B. N. Dugger, H. Fujishiro, Ronald Carl Petersen, Dennis W Dickson

Research output: Contribution to journalArticle

156 Citations (Scopus)

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=136) and intermediate/high likelihood DLB (DLB; n= 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%. Conclusions: Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.

Original languageEnglish (US)
Pages (from-to)875-882
Number of pages8
JournalNeurology
Volume77
Issue number9
DOIs
StatePublished - Aug 30 2011

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REM Sleep Behavior Disorder
Lewy Body Disease
Dementia
Autopsy
Lewy Bodies
Diagnostics
Sleep
Inclusion
Frontotemporal Dementia
Parkinsonian Disorders
Consensus
Alzheimer Disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. / Ferman, Tanis Jill; Boeve, Bradley F; Smith, G. E.; Lin, S. C.; Silber, M. H.; Pedraza, Otto D; Wszolek, Zbigniew K; Graff Radford, Neill R; Uitti, R.; Van Gerpen, Jay A; Pao, W.; Knopman, David S; Pankratz, V. S.; Kantarci, Kejal M; Boot, B.; Parisi, Joseph E; Dugger, B. N.; Fujishiro, H.; Petersen, Ronald Carl; Dickson, Dennis W.

In: Neurology, Vol. 77, No. 9, 30.08.2011, p. 875-882.

Research output: Contribution to journalArticle

Ferman, Tanis Jill ; Boeve, Bradley F ; Smith, G. E. ; Lin, S. C. ; Silber, M. H. ; Pedraza, Otto D ; Wszolek, Zbigniew K ; Graff Radford, Neill R ; Uitti, R. ; Van Gerpen, Jay A ; Pao, W. ; Knopman, David S ; Pankratz, V. S. ; Kantarci, Kejal M ; Boot, B. ; Parisi, Joseph E ; Dugger, B. N. ; Fujishiro, H. ; Petersen, Ronald Carl ; Dickson, Dennis W. / Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. In: Neurology. 2011 ; Vol. 77, No. 9. pp. 875-882.
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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=136) and intermediate/high likelihood DLB (DLB; n= 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{\%}. Conclusions: Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.",
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AU - Ferman, Tanis Jill

AU - Boeve, Bradley F

AU - Smith, G. E.

AU - Lin, S. C.

AU - Silber, M. H.

AU - Pedraza, Otto D

AU - Wszolek, Zbigniew K

AU - Graff Radford, Neill R

AU - Uitti, R.

AU - Van Gerpen, Jay A

AU - Pao, W.

AU - Knopman, David S

AU - Pankratz, V. S.

AU - Kantarci, Kejal M

AU - Boot, B.

AU - Parisi, Joseph E

AU - Dugger, B. N.

AU - Fujishiro, H.

AU - Petersen, Ronald Carl

AU - Dickson, Dennis W

PY - 2011/8/30

Y1 - 2011/8/30

N2 - 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=136) and intermediate/high likelihood DLB (DLB; n= 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%. Conclusions: Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.

AB - 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=136) and intermediate/high likelihood DLB (DLB; n= 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%. Conclusions: Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.

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