Tousi Babak
Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA.
Curr Treat Options Neurol. 2017 Oct 9;19(11):42. doi: 10.1007/s11940-017-0478-x.
Proper diagnosis of dementia with Lewy bodies (DLB) in clinical practice remains suboptimal as many cases are misdiagnosed, usually as Alzheimer disease (AD) or Parkinson's disease (PD) and, in rare cases, psychosis. Therefore, it is important for patients with dementia to be thoroughly evaluated by a specialist who is familiar with current diagnostic tests and treatment options. New diagnostic criteria from the Dementia with Lewy Bodies Consortium have been developed to increase diagnostic sensitivity for DLB (Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium; McKeith et al.; Neurology, 89(1): 88-100). REM sleep behavior disorder (RBD) has been studied more thoroughly in correlation with DLB and is now considered a core feature. D2 receptor blocking antipsychotics, which can cause severe antipsychotic sensitivity, are now rarely prescribed for treatment. Therefore, severe antipsychotic sensitivity, which was a suggestive criterion for DLB diagnosis, is now listed as a supportive feature. Reduced DAT uptake in basal ganglia demonstrated by SPECT or PET imaging has high specificity (90%) for distinguishing DLB from AD. Reduced uptake on metaiodobenzylguanidine myocardial scintigraphy correlates with reduced postganglionic sympathetic cardiac innervation in Lewy body diseases, which can increase specificity for discriminating probable DLB from probable AD in milder cases of dementia. However, the latter is more commonly used in Japan and is not used in the USA. The evidence supporting the benefit of other therapeutic modalities is limited in DLB due to lack of extensive studies. There are no FDA-approved medications for the treatment of DLB, although some effective drugs have been used off label to treat various symptoms.
在临床实践中，路易体痴呆（DLB）的正确诊断仍不尽人意，因为许多病例被误诊，通常被误诊为阿尔茨海默病（AD）或帕金森病（PD），极少数情况下被误诊为精神病。因此，对于痴呆患者，由熟悉当前诊断测试和治疗方案的专家进行全面评估非常重要。路易体痴呆联盟制定了新的诊断标准，以提高对DLB的诊断敏感性（路易体痴呆的诊断和管理：DLB联盟的第四次共识报告；麦基思等人；《神经病学》，89(1): 88 - 100）。快速眼动睡眠行为障碍（RBD）与DLB的相关性得到了更深入的研究，现在被认为是一个核心特征。可导致严重抗精神病药物敏感性的D2受体阻断抗精神病药物，现在很少用于治疗。因此，曾作为DLB诊断提示标准的严重抗精神病药物敏感性，现在被列为支持性特征。单光子发射计算机断层扫描（SPECT）或正电子发射断层扫描（PET）成像显示基底节区多巴胺转运体（DAT）摄取减少，对于区分DLB和AD具有较高的特异性（90%）。间碘苄胍心肌闪烁显像摄取减少与路易体病中节后交感神经心脏去神经支配减少相关，这在较轻的痴呆病例中可提高区分可能的DLB和可能的AD的特异性。然而，后者在日本更常用，在美国不使用。由于缺乏广泛的研究，支持其他治疗方式益处的证据在DLB中有限。尽管一些有效药物已被用于非标签治疗各种症状，但美国食品药品监督管理局（FDA）尚未批准用于治疗DLB的药物。
