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Dementia with Lewy bodies

Last reviewed: 19 Aug 2025
Last updated: 19 Aug 2025

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

作者

Alan J. Lerner, MD

Professor of Neurology

Department of Neurology

University Hospitals Cleveland Medical Center

Case Western Reserve University

Cleveland

OH

利益声明

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

利益声明

MIE declares that he has no competing interests.

鸣谢

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.

利益声明

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

同行评议者

Bryan Bernard, PhD

Assistant Professor and Clinical Neuropsychologist

Department of Neurological Sciences

Rush University Medical Center

Chicago

IL

利益声明

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

利益声明

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

利益声明

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

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.

关键文献

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.全文  摘要

Expert Panel on Neurological Imaging, Soderlund KA, Austin MJ, et al. ACR appropriateness criteria® Dementia: 2024 update. J Am Coll Radiol. 2025 May;22(5s):S202-33.全文  摘要

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.全文  摘要

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. 摘要

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.全文  摘要

参考文献

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