Revisiting DLB Diagnosis: A Consideration of Prodromal DLB and of the Diagnostic Overlap With Alzheimer Disease

Ian McKeith, John-Paul Taylor, Alan Thomas, Paul Donaghy, Joseph Kane

Research output: Contribution to journalArticlepeer-review

63 Citations (Scopus)
267 Downloads (Pure)


Efforts to clinically diagnose cases having dementia with Lewy bodies (DLB) identify those with a characteristic clinical syndrome (probable DLB) at the expense of missing an equal, if not greater, number of cases who have atypical presentations thought to be associated with coexisting Alzheimer pathologies. This article argues that further efforts should now be made to characterize this atypical group that constitutes cases previously identified postmortem as the Lewy body variant of Alzheimer disease (AD) or as AD with Lewy bodies. Since such fine distinction is unlikely to be achieved on clinical grounds alone, this new diagnostic category will require robust biomarker validation. Turning to a consideration of early/prodromal diagnosis of both typical and atypical DLB cases, it is suggested that there will be at least 3 prototypical forms-a mild cognitive impairment variant, associated with early visuoperceptual and attentional deficits; a delirium onset DLB with provoked or spontaneous delirium as the presenting features; and a psychiatric disorder DLB with its primary presentation as a late-onset affective disorder or psychosis.

Original languageEnglish
Pages (from-to)249-53
JournalJournal of geriatric psychiatry and neurology
Issue number5
Early online date08 Aug 2016
Publication statusPublished - 01 Sep 2016
Externally publishedYes


  • Alzheimer Disease/diagnosis
  • Delirium/epidemiology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Disease Progression
  • Humans
  • Lewy Body Disease/diagnosis
  • Mental Status Schedule
  • Prodromal Symptoms

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