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Lookup NU author(s): Professor Ian McKeith
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DLB is now established as a relatively common form of dementia in older people and is part of a larger spectrum of LB disease which has diverse clinical presentations, including PD, primary autonomic failure and RBD. Recent modifications to clinical and pathological guidelines for the assessment and diagnosis of DLB have been made (McKeith et al., 2005) and these will require independent validation in a variety of settings. Suspicion of a DLB diagnosis should be raised in the presence of any one of the proposed core or suggestive features and may be supported by the use of specifically designed assessment scales and appropriate neuroimaging techniques. ChEIs offer the greatest hope for symptomatic improvement in both psychotic and cognitive features of DLB and seem to offer these benefits without significant compromise of motor function. Ongoing multicenter, double-blind, placebo-controlled studies will hopefully clarify these issues, whereas long-term studies are required to assess the duration of benefit. Antipsychotic drugs need to be used sparingly and only when other pharmacological and non-pharmacological approaches fail to prevent severe distress or injurious behavior to self or others. Clinicians should be vigilant for severe neuroleptic sensitivity reactions. Clonazepam may have a particular role in the management of sleep disorders but the role of other sedatives and anticonvulsants is unproven. New-generation antidepressants may be helpful for persistent depressive symptoms. Disease-modifying treatments are urgently required. Better understanding of the pathobiological processing of synuclein proteins could ultimately lead to the development of novel therapeutic interventions for DLB. © 2007 Elsevier B.V. All rights reserved.
Author(s): McKeith I
Publication type: Review
Publication status: Published
Journal: Handbook of Clinical Neurology
ISSN (print): 0072-9752