Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria
Dementia with Lewy bodies (DLB) is an insidious neurodegenerative disease characterised by a precipitous decline in cognition, sleep disturbances, motor impairment and psychiatric features. Recently, criteria for prodromal DLB (pDLB) including clinical features and biomarkers have been put forward t...
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MDPI AG
2022-11-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/12/12/1594 |
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| author | Joseph R. Phillips Elie Matar Kaylena A. Ehgoetz Martens Ahmed A. Moustafa Glenda M. Halliday Simon J. G. Lewis |
| author_facet | Joseph R. Phillips Elie Matar Kaylena A. Ehgoetz Martens Ahmed A. Moustafa Glenda M. Halliday Simon J. G. Lewis |
| author_sort | Joseph R. Phillips |
| collection | DOAJ |
| description | Dementia with Lewy bodies (DLB) is an insidious neurodegenerative disease characterised by a precipitous decline in cognition, sleep disturbances, motor impairment and psychiatric features. Recently, criteria for prodromal DLB (pDLB) including clinical features and biomarkers have been put forward to aid the classification and research of this ambiguous cohort of patients. Researchers can use these criteria to classify patients with mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) as either possible (either one core clinical feature or one biomarker are present) or probable pDLB (at least two core clinical features, or one core clinical feature and at least one biomarker present). However, as isolated REM sleep behaviour disorder (iRBD) confirmed with polysomnography (PSG) can be included as both a clinical and a biomarker feature, potentially reducing the specificity of these diagnostic criteria. To address this issue, the current study classified a cohort of 47 PSG-confirmed iRBD patients as probable prodromal DLB only in the presence of an additional core feature or if there was an additional non-PSG biomarker. Thirteen iRBD patients demonstrated MCI (iRBD-MCI). In the iRBD-MCI group, one presented with parkinsonism and was thus classified as probable pDLB, whilst the remaining 12 were classified as only possible pDLB. All patients performed three tasks designed to measure attentional deficits, visual hallucinations and visuospatial impairment. Patients also attended clinical follow-ups to monitor for transition to DLB or another synucleinopathy. Findings indicated that the only patient categorised by virtue of having two core clinical features as probable pDLB transitioned over 28 months to a diagnosis of DLB. The performance of this probable pDLB patient was also ranked second-highest for their hallucinatory behaviours and had comparatively lower visuospatial accuracy. These findings highlight the need for more stringent diagnostic research criteria for pDLB, given that only one of the 13 patients who would have satisfied the current guidelines for probable pDLB transitioned to DLB after two years and was indeed the patient with two orthogonal core clinical features. |
| first_indexed | 2024-03-09T17:16:20Z |
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| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T17:16:20Z |
| publishDate | 2022-11-01 |
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| spelling | doaj.art-8931b8ac410c42ed819512ec2ab8229d2023-11-24T13:38:24ZengMDPI AGBrain Sciences2076-34252022-11-011212159410.3390/brainsci12121594Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research CriteriaJoseph R. Phillips0Elie Matar1Kaylena A. Ehgoetz Martens2Ahmed A. Moustafa3Glenda M. Halliday4Simon J. G. Lewis5Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, AustraliaFaculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, AustraliaFaculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, AustraliaDepartment of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg 2092, South AfricaFaculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, AustraliaFaculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, AustraliaDementia with Lewy bodies (DLB) is an insidious neurodegenerative disease characterised by a precipitous decline in cognition, sleep disturbances, motor impairment and psychiatric features. Recently, criteria for prodromal DLB (pDLB) including clinical features and biomarkers have been put forward to aid the classification and research of this ambiguous cohort of patients. Researchers can use these criteria to classify patients with mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) as either possible (either one core clinical feature or one biomarker are present) or probable pDLB (at least two core clinical features, or one core clinical feature and at least one biomarker present). However, as isolated REM sleep behaviour disorder (iRBD) confirmed with polysomnography (PSG) can be included as both a clinical and a biomarker feature, potentially reducing the specificity of these diagnostic criteria. To address this issue, the current study classified a cohort of 47 PSG-confirmed iRBD patients as probable prodromal DLB only in the presence of an additional core feature or if there was an additional non-PSG biomarker. Thirteen iRBD patients demonstrated MCI (iRBD-MCI). In the iRBD-MCI group, one presented with parkinsonism and was thus classified as probable pDLB, whilst the remaining 12 were classified as only possible pDLB. All patients performed three tasks designed to measure attentional deficits, visual hallucinations and visuospatial impairment. Patients also attended clinical follow-ups to monitor for transition to DLB or another synucleinopathy. Findings indicated that the only patient categorised by virtue of having two core clinical features as probable pDLB transitioned over 28 months to a diagnosis of DLB. The performance of this probable pDLB patient was also ranked second-highest for their hallucinatory behaviours and had comparatively lower visuospatial accuracy. These findings highlight the need for more stringent diagnostic research criteria for pDLB, given that only one of the 13 patients who would have satisfied the current guidelines for probable pDLB transitioned to DLB after two years and was indeed the patient with two orthogonal core clinical features.https://www.mdpi.com/2076-3425/12/12/1594dementia with Lewy bodies (DLB)prodromaldiagnostic criteriavisual hallucinationsvisuospatialattention |
| spellingShingle | Joseph R. Phillips Elie Matar Kaylena A. Ehgoetz Martens Ahmed A. Moustafa Glenda M. Halliday Simon J. G. Lewis Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria Brain Sciences dementia with Lewy bodies (DLB) prodromal diagnostic criteria visual hallucinations visuospatial attention |
| title | Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria |
| title_full | Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria |
| title_fullStr | Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria |
| title_full_unstemmed | Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria |
| title_short | Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria |
| title_sort | exploring the sensitivity of prodromal dementia with lewy bodies research criteria |
| topic | dementia with Lewy bodies (DLB) prodromal diagnostic criteria visual hallucinations visuospatial attention |
| url | https://www.mdpi.com/2076-3425/12/12/1594 |
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