Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies

T. J. Ferman, B. F. Boeve, G. E. Smith, S. C. Lin, M. H. Silber, O. Pedraza, Z. Wszolek, N. R. Graff-Radford, R. Uitti, J. Van Gerpen, W. Pao, D. Knopman, V. S. Pankratz, K. Kantarci, B. Boot, J. E. Parisi, Brittany Dugger, H. Fujishiro, R. C. Petersen, D. W. Dickson

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)875-882
Number of pages8
JournalNeurology
Volume77
Issue number9
DOIs
StatePublished - Aug 30 2011
Externally publishedYes

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REM Sleep Behavior Disorder
Lewy Body Disease
Dementia
Autopsy
Lewy Bodies
Frontotemporal Dementia
Parkinsonian Disorders
Consensus
Alzheimer Disease

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Ferman, T. J., Boeve, B. F., Smith, G. E., Lin, S. C., Silber, M. H., Pedraza, O., ... Dickson, D. W. (2011). Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology, 77(9), 875-882. https://doi.org/10.1212/WNL.0b013e31822c9148

Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. / Ferman, T. J.; Boeve, B. F.; Smith, G. E.; Lin, S. C.; Silber, M. H.; Pedraza, O.; Wszolek, Z.; Graff-Radford, N. R.; Uitti, R.; Van Gerpen, J.; Pao, W.; Knopman, D.; Pankratz, V. S.; Kantarci, K.; Boot, B.; Parisi, J. E.; Dugger, Brittany; Fujishiro, H.; Petersen, R. C.; Dickson, D. W.

In: Neurology, Vol. 77, No. 9, 30.08.2011, p. 875-882.

Research output: Contribution to journalArticle

Ferman, TJ, Boeve, BF, Smith, GE, Lin, SC, Silber, MH, Pedraza, O, Wszolek, Z, Graff-Radford, NR, Uitti, R, Van Gerpen, J, Pao, W, Knopman, D, Pankratz, VS, Kantarci, K, Boot, B, Parisi, JE, Dugger, B, Fujishiro, H, Petersen, RC & Dickson, DW 2011, 'Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies', Neurology, vol. 77, no. 9, pp. 875-882. https://doi.org/10.1212/WNL.0b013e31822c9148
Ferman TJ, Boeve BF, Smith GE, Lin SC, Silber MH, Pedraza O et al. Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology. 2011 Aug 30;77(9):875-882. https://doi.org/10.1212/WNL.0b013e31822c9148
Ferman, T. J. ; Boeve, B. F. ; Smith, G. E. ; Lin, S. C. ; Silber, M. H. ; Pedraza, O. ; Wszolek, Z. ; Graff-Radford, N. R. ; Uitti, R. ; Van Gerpen, J. ; Pao, W. ; Knopman, D. ; Pankratz, V. S. ; Kantarci, K. ; Boot, B. ; Parisi, J. E. ; Dugger, Brittany ; Fujishiro, H. ; Petersen, R. C. ; Dickson, D. W. / Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. In: Neurology. 2011 ; Vol. 77, No. 9. pp. 875-882.
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T1 - Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies

AU - Ferman, T. J.

AU - Boeve, B. F.

AU - Smith, G. E.

AU - Lin, S. C.

AU - Silber, M. H.

AU - Pedraza, O.

AU - Wszolek, Z.

AU - Graff-Radford, N. R.

AU - Uitti, R.

AU - Van Gerpen, J.

AU - Pao, W.

AU - Knopman, D.

AU - Pankratz, V. S.

AU - Kantarci, K.

AU - Boot, B.

AU - Parisi, J. E.

AU - Dugger, Brittany

AU - Fujishiro, H.

AU - Petersen, R. C.

AU - Dickson, D. W.

PY - 2011/8/30

Y1 - 2011/8/30

N2 - 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.

AB - 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.

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