Document Detail

Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop.
MedLine Citation:
PMID:  8909416     Owner:  NLM     Status:  MEDLINE    
Recent neuropathologic autopsy studies found that 15 to 25% of elderly demented patients have Lewy bodies (LB) in their brainstem and cortex, and in hospital series this may constitute the most common pathologic subgroup after pure Alzheimer's disease (AD). The Consortium on Dementia with Lewy bodies met to establish consensus guidelines for the clinical diagnosis of dementia with Lewy bodies (DLB) and to establish a common framework for the assessment and characterization of pathologic lesions at autopsy. The importance of accurate antemortem diagnosis of DLB includes a characteristic and often rapidly progressive clinical syndrome, a need for particular caution with neuroleptic medication, and the possibility that DLB patients may be particularly responsive to cholinesterase inhibitors. We identified progressive disabling mental impairment progressing to dementia as the central feature of DLB. Attentional impairments and disproportionate problem solving and visuospatial difficulties are often early and prominent. Fluctuation in cognitive function, persistent well-formed visual hallucinations, and spontaneous motor features of parkinsonism are core features with diagnostic significance in discriminating DLB from AD and other dementias. Appropriate clinical methods for eliciting these key symptoms are described. Brainstem or cortical LB are the only features considered essential for a pathologic diagnosis of DLB, although Lewy-related neurites, Alzheimer pathology, and spongiform change may also be seen. We identified optimal staining methods for each of these and devised a protocol for the evaluation of cortical LB frequency based on a brain sampling procedure consistent with CERAD. This allows cases to be classified into brainstem predominant, limbic (transitional), and neocortical subtypes, using a simple scoring system based on the relative distribution of semiquantitative LB counts. Alzheimer pathology is also frequently present in DLB, usually as diffuse or neuritic plaques, neocortical neurofibrillary tangles being much less common. The precise nosological relationship between DLB and AD remains uncertain, as does that between DLB and patients with Parkinson's disease who subsequently develop neuropsychiatric features. Finally, we recommend procedures for the selective sampling and storage of frozen tissue for a variety of neurochemical assays, which together with developments in molecular genetics, should assist future refinements of diagnosis and classification.
I G McKeith; D Galasko; K Kosaka; E K Perry; D W Dickson; L A Hansen; D P Salmon; J Lowe; S S Mirra; E J Byrne; G Lennox; N P Quinn; J A Edwardson; P G Ince; C Bergeron; A Burns; B L Miller; S Lovestone; D Collerton; E N Jansen; C Ballard; R A de Vos; G K Wilcock; K A Jellinger; R H Perry
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Publication Detail:
Type:  Guideline; Journal Article; Practice Guideline; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Neurology     Volume:  47     ISSN:  0028-3878     ISO Abbreviation:  Neurology     Publication Date:  1996 Nov 
Date Detail:
Created Date:  1996-12-18     Completed Date:  1996-12-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1113-24     Citation Subset:  AIM; IM    
Department of Old Age Psychiatry, Newcastle General Hospital, Newcastle upon Tyne, U.K.
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MeSH Terms
Dementia / pathology*
Parkinson Disease / pathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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