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Comparative Study
. 2011 Aug 30;77(9):875-82.
doi: 10.1212/WNL.0b013e31822c9148. Epub 2011 Aug 17.

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

T J Ferman  1 , 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, B N Dugger, H Fujishiro, R C Petersen, D W Dickson
Affiliations
Comparative Study

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

T J Ferman et al. Neurology. .

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.

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