Revisiting DLB Diagnosis: A Consideration of Prodromal DLB and of the Diagnostic Overlap With Alzheimer Disease
Revisiting DLB Diagnosis: A Consideration of Prodromal DLB and of the Diagnostic Overlap With Alzheimer Disease
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DOI：
10.1177/0891988716656083
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发表时间：
2016-09-01
影响因子：
2.6
通讯作者：
Kane, Joseph
中科院分区：
文献类型：
--
作者：
McKeith, Ian;Taylor, John-Paul;Kane, Joseph
临床诊断患有路易体痴呆（DLB）的病例的努力鉴定了具有特征性临床综合征（可能的DLB）的那些病例，代价是错过了同等数量（如果不是更多的话）的具有被认为与共存的阿尔茨海默病病理相关的非典型表现的病例。本文认为，现在应该进一步努力，以表征这一非典型组，构成以前确定的情况下，死后的路易体变异的阿尔茨海默病（AD）或AD与路易体。由于这种精细的区分不太可能仅在临床上实现，因此这种新的诊断类别将需要强大的生物标志物验证。考虑到典型和非典型DLB病例的早期/前驱诊断，建议至少有3种原型形式：轻度认知障碍变体，与早期视觉感知和注意力缺陷相关;谵妄发作DLB，以激发性或自发性谵妄为表现特征;精神障碍DLB，其主要表现为迟发性情感障碍或精神病。
Efforts to clinically diagnose cases having dementia with Lewy bodies (DLB) identify those with a characteristic clinical syndrome (probable DLB) at the expense of missing an equal, if not greater, number of cases who have atypical presentations thought to be associated with coexisting Alzheimer pathologies. This article argues that further efforts should now be made to characterize this atypical group that constitutes cases previously identified postmortem as the Lewy body variant of Alzheimer disease (AD) or as AD with Lewy bodies. Since such fine distinction is unlikely to be achieved on clinical grounds alone, this new diagnostic category will require robust biomarker validation. Turning to a consideration of early/prodromal diagnosis of both typical and atypical DLB cases, it is suggested that there will be at least 3 prototypical formsa mild cognitive impairment variant, associated with early visuoperceptual and attentional deficits; a delirium onset DLB with provoked or spontaneous delirium as the presenting features; and a psychiatric disorder DLB with its primary presentation as a late-onset affective disorder or psychosis.