Abstract：
Research criteria for the diagnosis of prodromal dementia with Lewy bodies (DLB) include three clinical subtypes: mild cognitive impairment with Lewy bodies (MCI-LB), delirium-onset prodromal DLB, and psychiatric-onset prodromal DLB. Late-onset psychiatric manifestations are at a higher risk of developing dementia, but its relation to prodromal DLB remains unclear. In addition to the risk of severe antipsychotic hypersensitivity reactions, accurate discrimination from non-DLB cases is important due to the potential differences in management and prognosis. This article aims to review a rapidly evolving psychiatric topic and outline clinical pictures of psychiatric-onset prodromal DLB, including the proposed biomarker findings of MCI-LB: polysomnography-confirmed rapid eye movement sleep behaviour disorder, cardiac [123I]metaiodobenzylguanidine scintigraphy, and striatal dopamine transporter imaging. We first reviewed clinical pictures of patients with autopsy-confirmed DLB. Regarding clinical reports, we focused on the patients who predominantly presented with psychiatric manifestations and subsequently developed DLB. Thereafter, we reviewed clinical studies regarding the diagnostic applications of the proposed biomarkers to patients with late-onset psychiatric disorders. Clinical presentations were mainly late-onset depression and psychosis; however, other clinical manifestations were also reported. Psychotropic medications before a DLB diagnosis may cause extrapyramidal signs, and potentially influences the proposed biomarker findings. These risks complicate clinical manifestation interpretation during the management of psychiatric symptoms. Longitudinal follow-up studies with standardised evaluations until conversion to DLB are needed to investigate the temporal trajectories of core features and proposed biomarker findings. In patients with late-onset psychiatric disorders, identification of patients with psychiatric-onset prodromal DLB provides the opportunity to better understanding the distinct prognostic subgroup that is at great risk of incident dementia. Advances in the establishment of direct biomarkers for the detection of pathological α-synuclein may encourage reorganising the phenotypic variability of prodromal DLB.
摘要：
路易体前驱痴呆（DLB）的诊断标准包括三种临床亚型：路易体轻度认知障碍（MCI-LB），谵妄发作的前驱DLB，和精神病发作的前驱DLB。迟发性精神病表现患痴呆症的风险更高，但其与前驱DLB的关系尚不清楚。除了严重的抗精神病药物超敏反应的风险，由于治疗和预后的潜在差异,与非DLB病例的准确区分非常重要.本文旨在回顾一个快速发展的精神病学主题，并概述精神病性前驱DLB的临床图片，包括MCI-LB的拟议生物标志物发现：多导睡眠图证实的快速眼动睡眠行为障碍，心脏[123I]间碘苄基胍闪烁显像，纹状体多巴胺转运蛋白成像。我们首先回顾了尸检证实的DLB患者的临床图片。关于临床报告，我们重点关注主要表现为精神病表现并随后发展为DLB的患者.此后,我们回顾了有关拟议的生物标志物对迟发性精神疾病患者的诊断应用的临床研究.临床表现主要是晚发性抑郁症和精神病；然而，还报告了其他临床表现。DLB诊断前的精神药物可能会引起锥体外系症状，并可能影响拟议的生物标志物发现。这些风险使精神症状管理期间的临床表现解释复杂化。需要进行纵向随访研究，进行标准化评估，直到转化为DLB，以调查核心特征的时间轨迹和提出的生物标志物发现。在患有迟发性精神疾病的患者中，对精神病性发病的前驱性DLB患者的识别提供了机会,可以更好地了解发生痴呆的风险非常大的不同的预后亚组.建立用于检测病理性α-突触核蛋白的直接生物标志物的进展可能会促进重组前驱DLB的表型变异性。
