Natural History

Early studies of the survival of DLB patients suggested that they decline much more rapidly than AD patients. More recent evidence has suggested that the DLB outcome data are skewed by individuals with rapidly progressive disease and that the overall rate of decline may be similar to that of AD.

McKeith and colleagues (1992b) have attempted to describe the typical clinical course of DLB. The first stage lasts from 1 to 3 years before the patient's presentation and is characterized by memory lapses. The patient may have episodes of delirium with medical illnesses. In the second stage, patients commonly present to clinicians. Attentional impairment and other cognitive dysfunction, apathy, hallucinations, and sleep disturbances are noted as are bradykinesia and gait impairment. The clinical fluctuation characteristic of DLB is often noted in the second stage. In the third and final stage of DLB, patients progress to a severe dementia over months to years, and behavioral problems, especially disorganization, are prominent. Clinical fluctuation persists in the third stage, and some periods of relative lucidity can be seen. End-stage DLB patients experience severe flexion and immobility like PD and AD patients, and death is similarly due to cardiac or pulmonary disease.

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