An Approach to Establish Antemortem Diagnosis of Dementia with Lewy Bodies

Abstract

Dementia with Lewy bodies (DLB) is a neurodegenerative disorder that is characterized by a progressive cognitive decline and the presence of numerous Lewy bodies (LBs) in the cortical and subcortical brain regions with a variable degree of coexisting Alzheimer-type pathology. DLB is likely to be the second most frequent cause of degenerative dementia after Alzheimer’s disease (AD) in the elderly. In 1996, the consortium on dementia with Lewy bodies (CDLB) proposed clinical and pathological criteria of DLB. However, some groups indicated a relatively poor sensitivity of the CDLB criteria to accurately detect DLB. Early and reliable antemortem detection of DLB as well as distinguishing DLB from AD are critically important for several reasons. First, extrapyramidal features of DLB patients are successfully treated by L-dopa in most cases. Further, DLB patients seem more likely to respond to Cholinesterase inhibitors than AD patients. Second, it is well documented that there is a great need to pay particular attention to life-threatening neuroleptic adverse effects in DLB. Finally, DLB may have a different rate of disease progression than AD. Here, we summarize our recent studies of functional brain imaging using positron emission tomography (PET) in an attempt to establish antemortem diagnosis of DLB.