Journal
NEUROLOGY
Volume 77, Issue 9, Pages 875-882Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e31822c9148
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Funding
- NIH [R01AG15866, P50AG16574, U01AG06786, P50NS072187]
- Mangurian Foundation for Lewy Body Dementia Research
- Cephalon, Inc.
- Allon Therapeutics, Inc.
- NIH/NIA
- Alzheimer's Association
- Mangurian Foundation
- NIH (NCRR)
- NIH (NINDS)
- Mayo Clinic Alzheimer's Disease Research Center
- Allergan, Inc.
- Pacific Alzheimer Research Foundation (Canada)
- CIHR
- Mayo Clinic Florida Research Committee
- Pfizer Inc
- Janssen
- Forest Laboratories, Inc.
- Medivation, Inc.
- Advanced Neuromodulations Systems
- Elan/Janssen AI
- Baxter International Inc.
- Cure PSP/Society for PSP
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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. Neurology (R) 2011;77:875-882
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