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Table 1 Revised criteria for the clinical diagnosis of Dementia with Lewy bodies (DLB)

From: FDG-PET in suspected dementia with Lewy bodies: a case report

Central feature (essential for a diagnosis of possible or probable DLB)
• Dementia defined as progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function
• Prominent or persistent memory impairment may not necessarily occur in the early stages but is usually evident with progression
• Deficits on tests of attention, executive function and visuospatial ability may be especially prominent
Core features (2 core features or 1 core feature with 1 or more indicative biomarkers for a diagnosis of probable DLB; 1 core feature for possible DLB)
• Fluctuating cognition with pronounced variation in attention and alertness.
• Recurrent visual hallucinations that are typically well formed and detailed
• REM sleep behavior disorder, which may precede cognitive decline
• Spontaneous features of parkinsonism
Supportive features
• Severe neuroleptic sensitivity
• Postural instability
• Severe autonomic dysfunction
• Hallucinations in other modalities, delusions, apathy, anxiety, and depression
Indicative biomarkers (if 1 or more indicative biomarkers is present but there is no core clinical features, possible DLB can be made)
• Reduced dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET
• Abnormal (low uptake) iodine123 - metaiodobenzyguanidine (MIBG) myocardial scintigraphy
• Polysomnographic confirmation of REM sleep without atonia
Supportive biomarkers
• Relative preservation of medial temporal lobe structures on CT/MRI scan
• Generalized low uptake on SPECT/PET perfusion/metabolism scan with reduced occipital activity +/− the cingulated island sign on FDG-PET imaging
• Prominent posterior slow wave activity on EEG with periodic fluctuations in the pre-alpha/theta range
From McKeith IG, Boeve BF, Dickson DW et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017; 89(1): 88–100.