Galvin James E
Continuum (Minneap Minn). 2024 Dec 1;30(6):1673-1698. doi: 10.1212/CON.0000000000001496.
Lewy body dementia (LBD) is an umbrella term describing two closely related conditions: Parkinson disease dementia (PDD) and dementia with Lewy bodies (DLB). LBD is the second most common cause of neurodegenerative dementia but is often underrecognized in clinical practice. This review covers the key epidemiologic, clinical, cognitive, behavioral, and biomarker features of LBD and discusses current treatment options.
Indicative biomarkers of LBD improve the ability to make a diagnosis and include single-photon emission computed tomography (SPECT) of the dopamine system (brain) and the noradrenergic system (cardiac), and polysomnography. α-Synuclein-specific biomarkers in spinal fluid, skin, plasma, and brain imaging are in active development with some available for clinical use. Prodromal stages of PDD and DLB have been contextualized, and diagnostic criteria have been published. An emerging theme is whether an integrated staging system focusing on protein aggregation, rather than clinical symptoms, may advance research efforts.
LBD is a common cause of cognitive impairment in older adults but is often subject to significant delays in diagnosis and treatment, increasing the burden on patients and family care partners. Understanding key features of disease and the use of biomarkers will improve recognition. Earlier detection may also facilitate the development of new therapeutics and enrollment in clinical trials.
路易体痴呆（LBD）是一个概括性术语，描述两种密切相关的病症：帕金森病痴呆（PDD）和路易体痴呆（DLB）。LBD是神经退行性痴呆的第二大常见病因，但在临床实践中常常未得到充分认识。本综述涵盖LBD的关键流行病学、临床、认知、行为和生物标志物特征，并讨论当前的治疗选择。
LBD的指示性生物标志物提高了诊断能力，包括多巴胺系统（脑部）和去甲肾上腺素能系统（心脏）的单光子发射计算机断层扫描（SPECT）以及多导睡眠图。脑脊液、皮肤、血浆和脑成像中的α-突触核蛋白特异性生物标志物正在积极研发中，有些已可供临床使用。PDD和DLB的前驱期已得到界定，诊断标准也已公布。一个新出现的主题是，专注于蛋白质聚集而非临床症状的综合分期系统是否可能推动研究工作。
LBD是老年人认知障碍的常见病因，但在诊断和治疗方面往往会出现显著延迟，增加了患者和家庭护理伙伴的负担。了解疾病的关键特征并使用生物标志物将提高识别率。早期检测也可能有助于开发新的治疗方法并使患者能够参加临床试验。
