Prodromal dementia with Lewy bodies

Area of Science:

• Neurodegenerative Disorders
• Neurology
• Geriatrics

Background:

• Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease (AD).
• Limited information exists on the prodromal state of DLB compared to AD.
• Parkinson's disease (PD) and DLB share prodromal symptoms indicative of Lewy body disease (LBD).

Purpose of the Study:

• To review the limited literature on the clinical profiles of prodromal DLB.
• To highlight the importance of identifying prodromal LBD symptoms for early prediction and intervention.
• To discuss the role of Rapid Eye Movement sleep Behavior Disorder (RBD) in DLB progression.

Main Methods:

• Literature review of clinical profiles of prodromal DLB.
• Analysis of shared prodromal symptoms between PD and DLB.
• Discussion of neuroimaging techniques for predicting LBD pathophysiology.

Main Results:

• Prodromal symptoms of DLB include dysautonomia, olfactory dysfunction, RBD, and psychiatric symptoms, often preceding dementia by years.
• Rapid Eye Movement sleep Behavior Disorder (RBD) is a potentially accurate prodromal predictor, though its impact on disease progression may vary.
• Occipital hypoperfusion/hypometabolism and specific neuroimaging findings can aid in predicting LBD pathophysiology in non-demented individuals.

Conclusions:

• Early identification of prodromal DLB symptoms, particularly RBD, is vital for understanding disease progression and enabling timely therapeutic interventions.
• Further large-scale, multi-site studies with pathological verification are needed to clarify the clinical relevance and diversity of DLB progression.
• The long prodromal phase of DLB offers a critical window for disease-modifying therapies, contingent on accurate identification of clinical trajectories.