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Neurodegeneration
Research paper
Accuracy of clinical diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis
  1. Giovanni Rizzo1,2,
  2. Simona Arcuti3,4,
  3. Massimiliano Copetti4,
  4. Maria Alessandria3,
  5. Rodolfo Savica5,
  6. Andrea Fontana4,
  7. Rocco Liguori1,2,
  8. Giancarlo Logroscino3,6
  1. 1 IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
  2. 2 Department of Biomedical and Neuromotor Sciences, Unit of Neurology, University of Bologna, Bologna, Italy
  3. 3 Department of Clinical Research in Neurology, University of Bari, Tricase, Italy
  4. 4 Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
  5. 5 Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota
  6. 6 Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
  1. Correspondence to Professor Giancarlo Logroscino, Department of Clinical Research in Neurology, Neurodegenerative Diseases Unit, Pia Fondazione di Culto e Religione ‘Card. G. Panico’, Via San Pio n. 4, 73039, Tricase (LE), Italy; giancarlo.logroscino{at}uniba.it

Abstract

Background The diagnosis of dementia with Lewy bodies (DLB) is based on diagnostic clinical criteria, which were updated over the years.

Objective To evaluate, through a systematic review, accuracy of the diagnostic criteria, testing a possible improvement over time.

Methods We searched on MEDLINE and SCOPUS databases for studies reporting diagnostic parameters regarding the clinical diagnosis of DLB until October 2016. We performed meta-analysis, using a Bayesian approach, on those using pathological examination as gold standard, subclassified based on the different diagnostic criteria used.

Results We selected 22 studies on 1585 patients. Pooled sensitivity, specificity and accuracy were 60.2%, 93.8%, 79.7%, respectively, for criteria antecedents to McKeith 1996. For McKeith 1996-possible, pooled sensitivity, specificity and accuracy were 65.6%, 80.6%, 77.9% in early stages and 72.3%, 64.3%, 66% in late stages, respectively. For McKeith 1996-probable, pooled sensitivity, specificity and accuracy were 19.4%, 95.1%, 77.7% in early stages and 48.6%, 88%, 79.2% in late stages, respectively. McKeith criteria 2005 were evaluated only in late stages: pooled sensitivity, specificity and accuracy were 91.3%, 66.7% and 81.6%, respectively, for possible diagnosis (only one study) and 88.3%, 80.8%, 90.7% for probable diagnosis, decreasing to 85.6%, 77.1% and 81.7% if only considering clinical settings focused on dementia diagnosis and care.

Conclusions and relevance Diagnostic criteria have become more sensitive and less specific over time, without substantial change in the accuracy. Based on current data, about 20% of DLB diagnosis are incorrect. Future studies are needed to evaluate if the recently released revised consensus criteria will improve the diagnostic accuracy of DLB.

  • lewy body dementia
  • clinical neurology
  • systematic reviews
  • meta-analysis

https://doi.org/10.1136/jnnp-2017-316844

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    Footnotes

    • Contributors GR and GL had full access to the data set of this study and take responsibility for the integrity of data and the accuracy of data analysis. Conception and design: GR and GL. Literature review: GR and MA. Articles screening, data collection and data set management: GR, SA, RS and MA. Statistical analysis and interpretation of data: GR, SA, MC, AF, RL and GL. First draft of manuscript: GR, SA and MC. Critical revision of manuscript: SA, RS, RL and GL. Supervision: GL. All authors made substantial contributions to the intellectual content of the paper and gave final approval for the final version of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from single studies used for this meta-analysis are available on request.