Ballard Clive G
Wolfson Research Centre, Institute for Ageing and Health, Newcastle General Hospital, Newcastle-upon-Tyne, UK.
Dement Geriatr Cogn Disord. 2004;17 Suppl 1:15-24. doi: 10.1159/000074678.
Significant advances have been made in neuropathologic identification procedures for dementia with Lewy bodies (DLB), but difficulties remain in clinical diagnosis. Consensus criteria state that the core features of DLB are fluctuating cognition with pronounced variation in attention and alertness, recurrent visual hallucinations and spontaneous motor features of parkinsonism. At least two of these features must be present for the diagnosis of probable DLB. Assessments of the validity of the consensus criteria against autopsy generally indicate high specificity but varying sensitivity. More detailed assessments of core diagnostic features or better operationalization, particularly of fluctuating cognition, may help improve the diagnostic guidelines. Greater utilization of some features described as supporting the diagnosis (such as auditory hallucinations) and the potential inclusion of additional symptoms (such as REM sleep behavioral disorder) also may be useful. In addition, the potential role of more detailed neuropsychology and neuroimaging in the diagnostic process needs to be evaluated, although it is important that changes to the diagnostic criteria are based on empirical evidence. Other key issues pertain to the classification of DLB patients with concurrent Alzheimer's disease and the differentiation of DLB and Parkinson's disease dementia based on less than a 1-year history of parkinsonism preceding the dementia.
路易体痴呆（DLB）的神经病理学鉴定程序已取得显著进展，但临床诊断仍存在困难。共识标准指出，DLB的核心特征是认知波动伴注意力和警觉性明显变化、反复出现的视幻觉以及帕金森病的自发运动特征。诊断可能的DLB必须具备这些特征中的至少两项。根据尸检对共识标准有效性的评估通常显示出高特异性，但敏感性各异。对核心诊断特征进行更详细的评估或更好地进行操作化，特别是对认知波动的操作化，可能有助于改进诊断指南。更多地利用一些被描述为支持诊断的特征（如听幻觉）以及可能纳入其他症状（如快速眼动睡眠行为障碍）也可能有用。此外，尽管重要的是诊断标准的改变要基于实证证据，但更详细的神经心理学和神经影像学在诊断过程中的潜在作用仍需评估。其他关键问题涉及并发阿尔茨海默病的DLB患者的分类，以及基于痴呆前帕金森病病史少于1年对DLB和帕金森病痴呆进行鉴别。
