Objective: To explore the validity of the currently accepted consensus criteria for Dementia with Lewy Bodies (DLB). We compared rates of DLB diagnosis in studies limited to clinical evaluations versus studies that examined autopsied brains from dementia patients who had no prior clinical diagnosis of specific etiology.
Design: We reviewed reports of DLB diagnosis since 1996, the year the consensus criteria were established. A number of studies (clinical studies) specifically noted the prevalence of DLB (using consensus criteria) in groups of demented patients; elderly controls were eliminated from all calculations. On the other hand, autopsy studies yielded prevalence rates via neuropathological examination of brains from patients with clinically unspecified dementias. The rates of DLB diagnosis obtained by these two methods were compared by a Pearson’s Chi-square analysis.
Materials and Methods: We conducted a Medline search with key words “Dementia with Lewy bodies and diagnosis,” seeking papers from 1996 through 2003.
Results: Four clinical studies, with a total of 377 demented patients, yielded a mean rate of DLB of 36.3% (range 30.2% - 58%). Seven autopsy studies (n=937) yielded a rate of 14.65 %DLB (range 8.4% - 25%). The Chi-square analysis demonstrated a highly significant difference between the two groups of studies (Pearson’s Chi-square= 76.83, df= 1, exact p= .000).
Conclusion: This comparison of the prevalence of clinically diagnosed DLB as opposed to the autopsy diagnoses suggests that DLB is being significantly over-diagnosed in the clinical setting. Factors that may explain a possible over-inclusiveness of the consensus criteria will be discussed.
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