Dementia with Lewy bodies: The emerging role of primary care

Figures & data

Table 1. Revised criteria for the clinical diagnosis of dementia with Lewy bodies. Adapted and based on McKeith et al. (12).

Central features^a	Core features^b	Suggestive features^c	Supportive features^d
Dementia defined as progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.	Fluctuating cognition disorder	Rapid eye movement sleep behaviour	Falls and syncopal episodes
Prominent or persistent memory impairment may not necessarily occur in the early stages but is usually evident with progression.	Recurrent visual hallucinations	Severe neuroleptic sensitivity	Transient, unexplained loss of consciousness
Deficits on tests of attention, executive function, and visuospatial ability may be especially prominent.	Spontaneous features of Parkinsonism emission tomography imaging	Low dopamine transporter uptake in basal ganglia demonstrated by single-photon emission computed tomography or positron	Severe autonomic dysfunction, e.g., orthostatic hypotension, urinary incontinenceHallucinations in non-visual modalitiesSystematic delusionsDepressionRelative preservation of medial temporal lobe structures on imaging (CT or MRI)Preservation of medial temporal lobe structures on CT/MRI scanLow uptake meta-iodobenzylguanidine myocardial scintigraphySlow wave activity on EEG with temporal lobe transient sharp waves

A diagnosis of DLB is less likely if there is evidence of cerebrovascular disease on imaging, any other physical illness or neurological disorder or if Parkinsonism appears in severe dementia.

^aEssential for possible or probable DLB.

^bTwo core features are needed for probable DLB, one for possible DLB.

^cDiagnosis of DLB can also be made if there is ≥ 1 suggestive feature is present in addition to ≥ 1 core feature. If there are only suggestive features then possible DLB can be diagnosed.

^dCommon at presentation but no diagnostic specificity.

CT, computed tomography; MRI, magnetic resonance imaging.

Table 2. History arousing suspicion for dementia with Lewy bodies.

1.	History of repeated unexplained falls.
2.	History of tremor/loss of facial expression/slowed movements.
3.	History of shouting out/active movements during sleep which might raise the suspicion of rapid eye movement sleep behaviour disorder.
4.	History of anosmia—often predates the occurrence of DLB by many years.
5.	Long standing constipation and postural blood pressure problems can also be a feature.
6.	Unexplained mild/subtle visual disturbances e.g. presence/passage hallucinations, illusions, problems with intermittent double vision.
7.	Recurrent history of unexplained delirium.

McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium. Neurology 2005;65:1863–72.

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