Journal Article

The clinical phenotype of psychiatric-onset prodromal dementia with Lewy bodies: a scoping review

Gunawardana, Chaminda Withanachchi, Matar, Elie, Lewis, Simon J. G.

2024

Overview

Background Recent consensus research criteria have identified a ‘psychiatric onset’ form of prodromal dementia with Lewy bodies (DLB) characterised by prominent late-onset psychiatric symptoms. Although recognised as important to raise the index of diagnostic suspicion, evidence regarding this cohort was deemed too limited to impose formal criteria. We reviewed the published literature on psychiatric-onset DLB to identify key clinical characteristics and evidence gaps to progress our understanding of this entity. Methods Medline, PubMed and Embase were searched for relevant articles containing longitudinal follow-up of patients initially presenting with a psychiatric illness who subsequently developed DLB according to the diagnostic criteria available at the time. Results Two cohort studies (18 and 21 patients) along with 12 case series (13 cases) were identified totalling 52 patients (63% female). Initial psychiatric presentation occurred at a mean of 63 years (range 53–88), with depression being the most frequently reported psychiatric presentation (88%). Psychotic presentations were less common on presentation (11%) but became more prevalent throughout the prodromal period before the diagnosis of DLB (83%). Relapses of the psychiatric disease were common occurring in 94% (32/34) of patients. Parkinsonism, cognitive fluctuations, visual hallucinations, and REM sleep behaviour disorder were uncommonly reported at initial presentation (3.8%). Conclusions Psychiatric-onset DLB is characterized by a female predominant relapsing–remitting psychiatric illness presenting with affective symptoms but later developing psychotic features prior to the onset of DLB. Additional prospective studies including other neurodegenerative cohorts with harmonised assessments are required to inform definitive diagnostic criteria for this condition.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Basal ganglia / Central nervous system diseases / Cognitive ability / Cohort Studies / Dementia / Dementia disorders / Female / Humans / Lewy bodies / Lewy Body Disease - diagnosis / Male / Medicine / Medicine & Public Health / Mental disorders / Middle Aged / Movement disorders / Neurological Update / Neurology / Neuroradiology / Neurosciences / Parkinsonian Disorders - diagnosis / Phenotype / Phenotypes / Prodromal Symptoms / Prospective Studies / Psychosis / REM sleep / Sleep disorders