Summary
Definition
History and exam
Key diagnostic factors
- fluctuations
- visual hallucinations
- motor symptoms
- rapid eye movement (REM) sleep behavioral disturbance
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
Risk factors
- older age
- familial occurrence
Diagnostic tests
1st tests to order
- serum thyroid-stimulating hormone (TSH)
- serum vitamin B12
- CT head
- MRI head
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
Treatment algorithm
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
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.
鉴别诊断
- Alzheimer disease
- Parkinson disease
- Frontotemporal dementia
更多 鉴别诊断指南
- ACR appropriateness criteria: dementia
- Management of REM sleep behavior disorder
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Alzheimer disease and other kinds of dementia
Caring for someone with dementia
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