Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.
Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium.
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DOI：
10.1212/wnl.0000000000004058
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发表时间：
2017-07-04
期刊：
影响因子：
9.9
通讯作者：
Kosaka K
中科院分区：
文献类型：
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作者：
McKeith IG;Boeve BF;Dickson DW;Halliday G;Taylor JP;Weintraub D;Aarsland D;Galvin J;Attems J;Ballard CG;Bayston A;Beach TG;Blanc F;Bohnen N;Bonanni L;Bras J;Brundin P;Burn D;Chen-Plotkin A;Duda JE;El-Agnaf O;Feldman H;Ferman TJ;Ffytche D;Fujishiro H;Galasko D;Goldman JG;Gomperts SN;Graff-Radford NR;Honig LS;Iranzo A;Kantarci K;Kaufer D;Kukull W;Lee VMY;Leverenz JB;Lewis S;Lippa C;Lunde A;Masellis M;Masliah E;McLean P;Mollenhauer B;Montine TJ;Moreno E;Mori E;Murray M;O'Brien JT;Orimo S;Postuma RB;Ramaswamy S;Ross OA;Salmon DP;Singleton A;Taylor A;Thomas A;Tiraboschi P;Toledo JB;Trojanowski JQ;Tsuang D;Walker Z;Yamada M;Kosaka K
路易体痴呆 (DLB) 联盟完善了有关 DLB 临床和病理诊断的建议，更新了过去十年来广泛使用的先前报告。修订后的 DLB 共识标准现在清楚地区分临床特征和诊断生物标志物，并就建立和解释这些特征的最佳方法提供指导。纳入了先前报道的 DLB 方面的大量新信息，增加了 REM 睡眠行为障碍和 123 碘-间碘苄胍 (MIBG) 心肌闪烁扫描的诊断权重。还描述了其他神经影像学、电生理学和实验室研究的诊断作用。建议对病理方法和标准进行少量修改，以考虑阿尔茨海默病的神经病理变化，添加先前省略的路易相关病理类别，并包括对黑质神经元损失的评估。由于 DLB 的随机对照试验很少，因此有关临床管理的建议主要基于专家意见。自上次报告以来，在 DLB 作为一种常见且重要的临床疾病的检测和认识方面取得了实质性进展。在此期间，它已被纳入 DSM-5，作为路易体的主要神经认知障碍。我们仍然迫切需要了解 DLB 的神经生物学和病理生理学基础，开发和开展针对症状药物和疾病缓解药物的临床试验，并帮助世界各地的患者和护理人员了解该疾病、其预后、最佳可用治疗方法、正在进行的研究以及如何获得足够的支持。
The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.