Dementia with Lewy bodies

Last reviewed: 6 Sep 2022
Last updated: 15 Sep 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • fluctuations
  • visual hallucinations
  • motor symptoms
  • rapid eye movement (REM) sleep behavioural disturbance
More key diagnostic factors

Other diagnostic factors

  • severe antipsychotic sensitivity
  • depression
  • anxiety
  • repeated falls and syncope
  • orthostatic hypotension
  • urinary symptoms
  • constipation
  • attentional and visual processing abnormalities
  • delusions
  • hypersomnia
  • hyposmia
  • auditory hallucinations
Other diagnostic factors

Risk factors

  • older age
  • familial occurrence
More risk factors

Diagnostic investigations

1st investigations to order

  • serum thyroid-stimulating hormone (TSH)
  • serum vitamin B12
  • CT head
  • MRI head
More 1st investigations to order

Investigations to consider

  • FBC
  • metabolic panel
  • serum folate
  • serum Venereal Disease Research Laboratory
  • urine drug screen
  • urinalysis
  • HIV testing
  • single-photon emission CT (SPECT)/positron emission tomography (PET)
  • quantitative EEG
  • polysomnography
  • cerebrospinal fluid (CSF) analysis
  • neuropsychological testing
  • MIBG myocardial scintigraphy
More investigations to consider

Treatment algorithm


all patients



Alan J. Lerner, MD

Professor of Neurology

Department of Neurology

University Hospitals Cleveland Medical Center

Case Western Reserve University




AJL receives research grant support from National Institutes of Health and has been a medicolegal consultant in several legal cases, but he declares that he has no competing interests related to this topic.

Mohamed I. Elkasaby, MD

Fellow in Behavioral Neurology and Neuropsychiatry

Department of Neurology

University Hospitals Cleveland Medical Center

Case Western Reserve University




MIE declares that he has no competing interests.


Dr Alan J. Lerner and Dr Mohamed I. Elkasaby would like to gratefully acknowledge Dr Brian S. Appleby, Dr Ethan Gore, Dr Rajeet Shrestha, Dr Timothy Wuerz, Dr Julie Schneider, Dr Viola Fahmy, and Dr Sube Banerjee, previous contributors to this topic.


BSA, EG, RS, TW, JS, VF, and SB declare that they have no competing interests.

Peer reviewers

Bryan Bernard, PhD

Assistant Professor and Clinical Neuropsychologist

Department of Neurological Sciences

Rush University Medical Center




BB declares that he has no competing interests.

James E. Galvin, MD, MPH

Associate Professor

Neurology, Psychiatry and Neurobiology


Memory Diagnostic Center and Alzheimer Treatment Unit


Education and Community Outreach

Alzheimer Disease Research Center

Washington University School of Medicine

St Louis



JEG declares that he has no competing interests.

Ian McKeith, MBBS

Professor of Old Age Psychiatry

Clinical Director

Institute for Ageing and Health

Newcastle University




IM is the author of several references cited in this topic.

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