title: Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies.
abstract: OBJECTIVE
  To determine whether adding REM sleep behavior disorder (RBD) to the dementia with Lewy bodies (DLB) diagnostic criteria improves classification accuracy of autopsy-confirmed DLB.
  
  
  METHODS
  We followed 234 consecutive patients with dementia until autopsy with a mean of 4 annual visits. Clinical diagnoses included DLB, Alzheimer disease (AD), corticobasal syndrome, and frontotemporal dementia. Pathologic diagnoses used the 2005 DLB consensus criteria and included no/low likelihood DLB (non-DLB; n = 136) and intermediate/high likelihood DLB (DLB; n = 98). Regression modeling and sensitivity/specificity analyses were used to evaluate the diagnostic role of RBD.
  
  
  RESULTS
  Each of the 3 core features increased the odds of autopsy-confirmed DLB up to 2-fold, and RBD increased the odds by 6-fold. When clinically probable DLB reflected dementia and 2 or more of the 3 core features, sensitivity was 85%, and specificity was 73%. When RBD was added and clinically probable DLB reflected 2 or more of 4 features, sensitivity improved to 88%. When dementia and RBD were also designated as probable DLB, sensitivity increased to 90% while specificity remained at 73%. The VH, parkinsonism, RBD model lowered sensitivity to 83%, but improved specificity to 85%.
  
  
  CONCLUSIONS
  Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL 32224, USA. ferman.tanis@mayo.edu
authors.forename: T J
authors.initials: TJ
authors.lastname: Ferman
authors.forename: B F
authors.initials: BF
authors.lastname: Boeve
authors.forename: G E
authors.initials: GE
authors.lastname: Smith
authors.forename: S-C
authors.initials: SC
authors.lastname: Lin
authors.forename: M H
authors.initials: MH
authors.lastname: Silber
authors.forename: O
authors.initials: O
authors.lastname: Pedraza
authors.forename: Z
authors.initials: Z
authors.lastname: Wszolek
authors.forename: N R
authors.initials: NR
authors.lastname: Graff-Radford
authors.forename: R
authors.initials: R
authors.lastname: Uitti
authors.forename: J
authors.initials: J
authors.lastname: Van Gerpen
authors.forename: W
authors.initials: W
authors.lastname: Pao
authors.forename: D
authors.initials: D
authors.lastname: Knopman
authors.forename: V S
authors.initials: VS
authors.lastname: Pankratz
authors.forename: K
authors.initials: K
authors.lastname: Kantarci
authors.forename: B
authors.initials: B
authors.lastname: Boot
authors.forename: J E
authors.initials: JE
authors.lastname: Parisi
authors.forename: B N
authors.initials: BN
authors.lastname: Dugger
authors.forename: H
authors.initials: H
authors.lastname: Fujishiro
authors.forename: R C
authors.initials: RC
authors.lastname: Petersen
authors.forename: D W
authors.initials: DW
authors.lastname: Dickson
mesh_terms: D000203:Activities of Daily Living; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020961:Lewy Body Disease / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires