Dementia with Lewy Bodies and Parkinson Disease with Dementia Within the Spectrum of Lewy Body Disease

Abstract

The history of Parkinson disease (PD) and dementia with Lewy bodies (DLB) is briefly presented. Since Lewy reported Lewy bodies in the brainstem nuclei of the PD brain in 1912, Lewy bodies had been considered an essential pathological finding for the diagnosis of PD. It had been, however, considered that there were almost no Lewy bodies occurring in the cerebral cortex. In 1976, we reported our first autopsied case showing numerous Lewy bodies in the cerebral cortex. In 1978, we reported the detailed characteristics and distribution pattern of cortical Lewy bodies, based on three autopsied cases showing diffuse Lewy body disease (DLBD), a term that we proposed in 1984. We also reported two German autopsied cases showing DLBD in 1979, which were the first DLBD cases reported in Europe. In 1980, we also proposed the term Lewy body disease and classified it into three types: brainstem type, transitional type, and diffuse type. The brainstem type is the same as PD, and the diffuse type was later designated DLBD. In 1990, we reviewed all the 37 DLBD cases reported in Japan and classified DLBD into two forms: a common form with more or less Alzheimer pathology and a pure form without such pathology. Since then, we have reported many papers ­concerning DLBD. The term dementia with Lewy bodies (DLB) was proposed at the first ­international workshop held in 1995. CDLB guidelines were published in 1996, and the CDLB guidelines–revised were reported in 2005. In the revised guidelines the term Lewy body disease was used as a generic term that included DLB, PD, and PDD, as we had insisted since 1980.