BRAIN and NERVE Shinkei Kenkyu no Shinpo Volume 70, Issue 8 (August 2018)

Revised 2017 Clinical Diagnostic Criteria for Dementia with Lewy Bodies: Inclusion of REM Sleep Behavior Disorder and Indicative Biomarkers Hiroshige Fujishiro 1 1Department of Psychiatry, Kawasaki Memorial Hospital Keyword: レヴィ小体型認知症 , パーキンソン病 , 病理診断 , アルツハイマー病 , 臨床経過 , DLB , Parkinson's disease , pathological diagnosis , Alzheimer disease , clinical course pp.869-877
Published Date 2018/8/1
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Although dementia with Lewy bodies (DLB) is the second most common neurodegenerative disorder after Alzheimer disease, its diagnostic sensitivity in clinical practice is sub-optimal. In 2017, the DLB clinical diagnostic criteria were modified to include the additional core feature of REM sleep behavior disorder (RBD) and three new indicative biomarkers. With this revision, clinically probable DLB is represented by two or more core features (fluctuations, parkinsonism, visual hallucinations, or RBD) or by one core feature plus one indicative biomarker (low striatal dopamine transporter uptake, reduced cardiac [123I]-metaiodobenzylguanidine uptake, or REM sleep without atonia on polysomnography). Because RBD is an early feature of DLB and often precedes the onset of other core features, a clinical history of RBD enables us to improve the low diagnostic sensitivity of DLB at the early stage of disease progression. Moreover, RBD is an accurate predictor of DLB in terms of the differential diagnosis of dementia based on clinicopathological findings. Increasing the detection rate of RBD with confirmation by indicative biomarkers provides greater diagnostic accuracy of DLB, even in the absence of other core features. This review focuses on the revised DLB clinical diagnostic criteria for identifying patients with probable DLB in clinical practice.

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BRAIN and NERVE-神経研究の進歩
70巻8号 (2018年8月)
電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院