Editors' note: Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium

Abstract

“Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium” proposed new criteria for the diagnosis of dementia with Lewy bodies (DLB), helping to distinguish DLB from Parkinson disease with dementia. Dr. Abe agrees with the need for new criteria and discusses how the hypothesis of Braak et al. of the rostral progression of brainstem synucleinopathy is not observed in DLB. Drs. Uchihara and Toru comment that the new criteria, in which combinations of clinical features and biomarkers lead to the diagnosis of possible or probable DLB, will make diagnosis easier and more precise. In the new criteria, reduced dopamine transporter (DAT) uptake in the basal ganglia seen on SPECT or PET was considered an indicative biomarker and, therefore, combined with one core clinical feature, is sufficient to diagnose probable DLB. Drs. Parmera et al. argue that low DAT uptake may be better classified as a supportive biomarker given that it is not as helpful in differentiating between diseases of presynaptic dopaminergic deficiency. Drs. Wang et al. request that visual hallucinations be better defined and further research be undertaken into the 1-year rule between the onset of dementia and parkinsonism. Author McKeith responds to all correspondents. He describes a study currently underway looking at modifying the existing DLB staging system using more extensive neuropathologic evaluation, explains the consortium's decision on including DAT uptake as an indicative biomarker rather than a supportive one, and offers guidance on visual hallucinations and the 1-year rule. “Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium” proposed new criteria for the diagnosis of dementia with Lewy bodies (DLB), helping to distinguish DLB from Parkinson disease with dementia. Dr. Abe agrees with the need for new criteria and discusses how the hypothesis of Braak et al. of the rostral progression of brainstem synucleinopathy is not observed in DLB.