title: Research evaluation and prospective diagnosis of dementia with Lewy bodies.
abstract: OBJECTIVE
  To evaluate the relative merits of recently developed criteria for dementia with Lewy bodies (DLBs) in a longitudinal study of dementia.
  
  
  METHODS
  The diagnosis of DLBs was used in combination with other clinical diagnosis. Patients were classified primarily based on the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) clinical criteria for probable or possible Alzheimer disease, or with other disease process that can cause dementia (eg, Parkinson disease), and secondarily according to the consensus guidelines for DLBs. This "double" clinical diagnosis was implemented to capture different pathological entities. The neuropathological diagnosis of Lewy bodies was made with monoclonal antibodies against alpha-synuclein.
  
  
  METHODS
  Multidisciplinary research clinic.
  
  
  RESULTS
  Prospective application of the consensus guidelines for DLBs from January 1, 1997, to September 29, 2000, identified 11 patients having the diagnosis of probable DLBs and 35 having possible DLBs. The diagnosis of probable or possible DLBs was associated with probable Alzheimer disease in 34 patients, with possible Alzheimer disease in 5 patients, with Parkinson disease in 2 patients, and with other disease processes in 2 patients. Three patients were diagnosed as having probable DLBs alone. An autopsy was performed in 26 of the cases who were clinically examined during the study period. Cortical Lewy bodies were identified in 13 cases; 4 had had premortem diagnosis of DLBs (sensitivity, 30.7%; specificity, 100%).
  
  
  CONCLUSIONS
  The prospective validation of the clinical criteria for DLBs showed poor accuracy in this series. We believe that current criteria for DLBs are useful when DLBs occur in isolation, but have low sensitivity when Lewy bodies coexist with the pathological abnormalities of Alzheimer disease.
authors.affiliation: Alzheimer's Disease Research Center, University of Pittsburgh, Pa, USA.
authors.forename: Oscar L
authors.initials: OL
authors.lastname: Lopez
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Kaufer
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hamilton
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sweet
authors.forename: William
authors.initials: W
authors.lastname: Klunk
authors.forename: Steven T
authors.initials: ST
authors.lastname: DeKosky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000473:pathology; D005260:Female; D006801:Humans; D016631:Lewy Bodies / Q000473:pathology; D020961:Lewy Body Disease / Q000145:classification / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity