Diagnostic and other biomarkers of dementia with Lewy bodies: from research to clinical settings.

Abstract

Dementia with Lewy bodies is characterised clinically by visual hallucinations, fluctuating cognitive function, parkinsonism, and rapid eye movement sleep behaviour disorder, and can cause more frailty than other dementias. The disease is heterogeneous in presentation and progression, and misdiagnoses are common. In people with dementia with Lewy bodies, other brain copathologies are frequent, limiting the usefulness of some diagnostic biomarkers. This heterogeneity, together with the scarcity of diagnostic and prognostic biomarkers, has hindered the implementation of therapeutic trials. However, novel neuroimaging techniques have emerged with high sensitivity to brain tissue composition and microstructure. Fluid biomarkers are being developed to detect very low concentrations of neuropathological proteins. These biomarkers could soon be adopted in clinical practice and incorporated as outcome measures in clinical trials. These advances will pave the way for early diagnosis, disease monitoring, and prognosis, and will facilitate the implementation of disease-modifying trials.