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Dementia with Lewy bodies

Last reviewed: 9 Apr 2025
Last updated: 20 Jun 2023

Summary

Definition

History and exam

Key diagnostic factors

  • fluctuations
  • visual hallucinations
  • motor symptoms
  • rapid eye movement (REM) sleep behavioral disturbance
Full details

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
Full details

Risk factors

  • older age
  • familial occurrence
Full details

Diagnostic tests

1st tests to order

  • serum thyroid-stimulating hormone (TSH)
  • serum vitamin B12
  • CT head
  • MRI head
Full details

Tests to consider

  • CBC
  • 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
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Alan J. Lerner, MD

Professor of Neurology

Department of Neurology

University Hospitals Cleveland Medical Center

Case Western Reserve University

Cleveland

OH

Disclosures

AJL declares that he has no competing interests.

Mohamed I. Elkasaby, MD

Fellow in Behavioral Neurology and Neuropsychiatry

Department of Neurology

University Hospitals Cleveland Medical Center

Case Western Reserve University

Cleveland

OH

Disclosures

MIE declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Chicago

IL

Disclosures

BB declares that he has no competing interests.

James E. Galvin, MD, MPH

Associate Professor

Neurology, Psychiatry and Neurobiology

Director

Memory Diagnostic Center and Alzheimer Treatment Unit

Director

Education and Community Outreach

Alzheimer Disease Research Center

Washington University School of Medicine

St Louis

MO

Disclosures

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

Newcastle

UK

Disclosures

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

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology. 2017 Jul 4;89(1):88-100.Full text  Abstract

Expert Panel on Neurological Imaging; Moonis G, Subramaniam RM, Trofimova A, et al. ACR Appropriateness Criteria® dementia. J Am Coll Radiol. 2020 May;17(5s):S100-12.Full text  Abstract

Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia. Lancet Neurol. 2020 Feb;19(2):157-69.Full text  Abstract

American College of Radiology. ACR-ACNM-ASNR-SNMMI practice parameter for brain PET-CT imaging in dementia. 2020 [internet publication].Full text

O'Brien JT, Holmes C, Jones M, et al. Clinical practice with anti-dementia drugs: a revised (third) consensus statement from the British Association for Psychopharmacology. J Psychopharmacol. 2017 Feb;31(2):147-68. Abstract

Rolinski M, Fox C, Maidment I, et al. Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson's disease dementia and cognitive impairment in Parkinson's disease. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD006504.Full text  Abstract

Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016 May 1;173(5):543-6.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Alzheimer disease
    • Parkinson disease
    • Frontotemporal dementia
    More Differentials
  • Guidelines

    • Management of REM sleep behavior disorder​
    • ACR appropriateness criteria: dementia
    More Guidelines
  • Patient information

    Alzheimer disease and other kinds of dementia

    Caring for someone with dementia

    More Patient information
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