DEMENTIA WITH LEWY BODIES (DLB): NEW DIAGNOSTIC CONCEPTS

Abstract

Existing criteria for the clinical diagnosis of dementia with Lewy bodies (DLB) have been criticised as having limited diagnostic sensitivity. The criteria are directed towards identifying cases with established, rather than early stage dementia. In order to address these issues the DLB international consortium met to reconsider diagnostic methods as part of a general update of the field. Consortium members were asked to review the current consensus recommendations and to: 1) identify elements in need of amendment; 2) suggest new topics for potential inclusion and 3) identify any anticipated future developments, under the general headings of 1) clinical diagnosis, 2) clinical management and trial design, 3) pathology, genetics, biofluids and basic science and 4) global harmonization. Revised recommendations for the clinical diagnosis of DLB have been made which distinguish more clearly than before between clinical features and biomarkers, and which assign slightly different weighting to items than previously. These revised criteria now need to be tested in prospective autopsy validation studies that take account of clinico-pathological heterogeneity, particularly the interaction with different Alzheimer pathologies. Additional criteria for the diagnosis of prodromal DLB, or for prodromal LB disease, remain to be formally developed. Improved diagnostic criteria for DLB and related clinical syndromes are needed to more precisely characterise the significant phenotypic variation which exists. This will be particularly significant for the design of intervention trials, both symptomatic and disease modifying. In this session the revised criteria for DLB will be presented, and initial proposals for prodromal disease will be discussed.