Diagnostic Criteria for Dementia with Lewy Bodies (DLB)

Synucleinopathies, with and without dementia, encompass a wide range of diseases including Parkinson's disease, multiple system atrophy, rapid eye movement (REM) sleep behavior disorder, and dementia with Lewy bodies (DLB). DLB is a neurodegenerative disorder resulting in slowly progressive and unrelenting dementia until death.

Diagnostic Criteria for Dementia with Lewy Bodies (DLB)

Central feature

• Progressive dementia: deficits in attention and executive function are typical. Prominent memory impairment may not be evident in the early stages.

Core features:

• Fluctuating cognition with pronounced variations in attention and alertness.
• Recurrent complex visual hallucinations
• Spontaneous features of Parkinsonism.

Suggestive features:

• REM sleep behaviour disorder (RBD), which can appear years before the onset of dementia and Parkinsonism.
• Severe sensitivity to neuroleptics occurs in up to 50% of DLB patients who take them.
• Low dopamine transporter uptake in the brain's basal ganglia as seen on SPECT and PET imaging scans.

Supportive features:

• Repeated falls and syncope (fainting).
• Transient, unexplained loss of consciousness.
• Autonomic dysfunction.
• Hallucinations of other modalities.
• Visuospatial abnormalities like depth perception, object orientation, directional sense and illusions
• Other psychiatric disturbances like systematized delusions, aggression and depression.

A probable DLB diagnosis requires either:

• Dementia plus two or more core features, or
• Dementia plus one core feature and one or more suggestive features.

A possible DLB diagnosis requires:

• Dementia plus one core feature, or
• Dementia plus one or more suggestive features.

References:

1. McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, Cummings J, Duda JE, Lippa C, Perry EK, Aarsland D, Arai H, Ballard CG, Boeve B, Burn DJ, Costa D, Del Ser T, Dubois B, Galasko D, Gauthier S, Goetz CG, Gomez-Tortosa E, Halliday G, Hansen LA, Hardy J, Iwatsubo T, Kalaria RN, Kaufer D, Kenny RA, Korczyn A, Kosaka K, Lee VM, Lees A, Litvan I, Londos E, Lopez OL, Minoshima S, Mizuno Y, Molina JA, Mukaetova-Ladinska EB, Pasquier F, Perry RH, Schulz JB, Trojanowski JQ, Yamada M; Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005 Dec 27;65(12):1863-72. [Medline]
2. Weisman D, McKeith I. Dementia with Lewy bodies. Semin Neurol. 2007 Feb;27(1):42-7.[Medline]

Caregiving strategies for older adults with delirium, dementia and depression

Description of Methods Used to Formulate the Recommendations

June 2004 Guideline
In January of 2003, a panel of nurses and researchers with expertise in practice, education, and research related to gerontology and geriatric mental health care was convened under the auspices of the Registered Nurses' Association of Ontario (RNAO). At the onset, the panel discussed and came to a consensus on the scope of the best practice guideline.
Following the extraction of identified recommendations and content from eight guidelines, the panel underwent a process of review, discussion, and consensus on the key evidence-based assessment criteria.
The panel members divided into subgroups to undergo specific activities using the short-listed guidelines, other literature, and additional resources for the purpose of drafting recommendations for nursing interventions. This process yielded a draft set of recommendations. The panel members as a whole reviewed the recommendations, discussed gaps and available evidence, and came to consensus on a draft guideline.