Updated consensus guidelines for dementia with Lewy bodies

The Dementia with Lewy Bodies Consortium has recently updated its recommendations on the clinical diagnosis and management of the condition.  Excellence Network clinical director David Burn, who is part of the Consortium, talks about the background to this work and how it can help improve care.

Who makes up the Dementia with Lewy Bodies Consortium and what is its purpose?

The Consortium is led by Professor Ian McKeith from Newcastle University and comprises a large international group of clinical academics and basic scientists. Collectively, the consortium has expertise to address all aspects of dementia with Lewy bodies, from disease pathophysiology to clinical management.

The purpose of the Consortium is to provide up to date information about the clinical and pathological diagnosis of dementia with Lewy bodies.

The purpose of the Consortium is to provide up to date information about the clinical and pathological diagnosis of dementia with Lewy bodies and also make recommendations about clinical management.

What prompted the consortium to review the previous report?

The previous report was published 10 years. Since then, our understanding of dementia with Lewy bodies, particularly with regard to the value of diagnostic investigations, has increased considerably.

Randomised trials of treatment for the condition are still few in number, but world-wide considerable clinical experience has accumulated in that time.  An update of the previous guidelines was therefore felt to be appropriate and clinically useful. 

How was the review conducted and how was consensus reached?

The update was carried out in 4 phases:

  1. scoping, which began in 2014, to review the previous recommendations
  2. working groups comprising 4 panels of international experts who formulated priority topics for discussion at the dementia with Lewy bodies international workshop
  3. work at the international workshop held in December 2015 to agree consensus
  4. post-conference activities including writing up of information from each working group, compilation of sections and editing.

The revised criteria now distinguish clearly between clinical features and diagnostic biomarkers.

What are the main ways the Consortium would like these guidelines to improve clinical practice? 

In the new publication, recommendations have been refined about the clinical and pathological diagnosis of dementia with Lewy bodies.

The revised criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these.

Notably, increased diagnostic weighting has been given to REM sleep behaviour disorder and 123 iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy.

We hope that these guidelines will help professionals understand more about the condition and ensure their patients receive the most appropriate care.

The consensus guidelines can be found in the latest edition of the Neurology journal.

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