Prodromal dementia with L ewy bodies

Dementia with L ewy bodies ( DLB ) is the second most common neurodegenerative dementing disorder after A lzheimer's disease ( AD ), but there is limited information regarding the prodromal DLB state compared with that of AD . P arkinson's disease ( PD ) and DLB share common prodromal symptoms with L ewy body disease ( LBD ), allowing us to use a common strategy for identifying the individuals with an underlying pathophysiology of LBD . Dysautonomia, olfactory dysfunction, rapid eye movement sleep behavior disorder ( RBD ) and psychiatric symptoms antedate the onset of dementia by years or even decades in patients with DLB . Although RBD is the most potentially accurate prodromal predictor of DLB , disease progression before the onset of dementia could differ between the prodromal DLB state with and without RBD . Experts who specialize in idiopathic RBD and DLB might need communication in order to clarify the clinical relevance of RBD with the disease progression of DLB . The presence of prodromal LBD symptoms or findings of occipital hypoperfusion/hypometabolism helps us to predict the possible pathophysiological process of LBD in non‐demented patients. This approach might provide the opportunity for additional neuroimaging, including cardiac 123 I ‐metaiodobenzylguanidine scintigraphy and dopamine transporter imaging. Although limited radiological findings in patients with prodromal DLB states have been reported, there is now a need for larger clinical multisite studies with pathological verification. The long prodromal phase of DLB provides a critical opportunity for potential intervention with disease‐modifying therapy, but only if we are able to clearly identify the diversity in the clinical courses of DLB . In the present article, we reviewed the limited literature regarding the clinical profiles of prodromal DLB . Geriatr Gerontol Int 2015; 15: 817–826.