McKeith Ian, Taylor John-Paul, Thomas Alan, Donaghy Paul, Kane Joseph
Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland.
J Geriatr Psychiatry Neurol. 2016 Sep;29(5):249-53. doi: 10.1177/0891988716656083.
Efforts to clinically diagnose cases having dementia with Lewy bodies (DLB) identify those with a characteristic clinical syndrome (probable DLB) at the expense of missing an equal, if not greater, number of cases who have atypical presentations thought to be associated with coexisting Alzheimer pathologies. This article argues that further efforts should now be made to characterize this atypical group that constitutes cases previously identified postmortem as the Lewy body variant of Alzheimer disease (AD) or as AD with Lewy bodies. Since such fine distinction is unlikely to be achieved on clinical grounds alone, this new diagnostic category will require robust biomarker validation. Turning to a consideration of early/prodromal diagnosis of both typical and atypical DLB cases, it is suggested that there will be at least 3 prototypical forms-a mild cognitive impairment variant, associated with early visuoperceptual and attentional deficits; a delirium onset DLB with provoked or spontaneous delirium as the presenting features; and a psychiatric disorder DLB with its primary presentation as a late-onset affective disorder or psychosis.
临床上诊断路易体痴呆（DLB）病例的努力，识别出具有特征性临床综合征的患者（可能的DLB），但代价是遗漏了数量相当甚至可能更多的具有非典型表现的病例，这些非典型表现被认为与并存的阿尔茨海默病病理相关。本文认为，现在应进一步努力对这一非典型群体进行特征描述，该群体包括先前尸检时被确定为阿尔茨海默病（AD）的路易体变异型或伴有路易体的AD的病例。由于仅靠临床依据不太可能实现如此精细的区分，这一新的诊断类别将需要可靠的生物标志物验证。在考虑典型和非典型DLB病例的早期/前驱期诊断时，有人提出至少会有3种原型形式——一种轻度认知障碍变异型，与早期视觉感知和注意力缺陷相关；一种以激惹性或自发性谵妄为表现特征的谵妄起病型DLB；以及一种以迟发性情感障碍或精神病为主要表现的精神障碍型DLB。
