DLB, Dementia with Lewy bodies (DLB) Options

[Graeber]

Dementia with Lewy bodies (DLB)

Alpha-synuclein immunohistochemistry should be used to identify Lewy bodies and Lewy neurites

Brain sampling should include (taking local standards into account): the superior or middle frontal gyrus, cingulate gyrus, nucleus accumbens, caudate and putamen, globus pallidus, nucleus basalis Meynert caudal to the anterior commissure, hippocampus and parahippocampal gyrus, superior or middle temporal gyrus, amygdala, parietal lobule, midbrain, pons, medulla with inferior olive, medulla with dorsal motor nucleus of the vagus nerve, cerebellar cortex with dentate nucleus, and spinal cord at three levels if possible

Cases can be classified into brainstem predominant, limbic (transitional), and neocortical subtypes; the pattern of regional involvement is more important than total Lewy body count.

Co-existing AD pathology makes the diagnosis of DLB less likely (generic AD criteria should be used, only neuritic plaques should be considered)

The severity of Lewy body and Lewy neurite pathology should be graded: 0-4 (3 and 4 with Lewy neurites)

The presence or absence of LBs in the amygdala needs to be documented in all cases of dementia. LBs in this location are correlated with visual hallucinations in DLB.