Kristian Steen Frederiksen, MD, PhD, FEBN, Danish Dementia Research Centre, Rigshospitalet, Copenhagen, Denmark, discusses the current understanding of the prodromal phase of dementia with Lewy bodies (DLB). Recently, diagnostic criteria were suggested for the prodromal phase in which three subtypes were proposed: cognitive, psychiatric, and delirium – implying that those clusters of symptoms could characterize the prodromal phase of DLB. A study investigated the prodromal phase in DLB and the frequency of the three subtypes. Patients diagnosed with DLB within a period of four years were retrospectively identified and matched to a group of patients with Alzheimer’s disease (AD). Patient case files were reviewed to examine the first symptoms and symptoms in the prodromal phase. Results showed that many patients with DLB presented cognitive impairment at onset, which was also observed in patients with AD. A smaller number of patients had primarily psychiatric symptoms, and only 2% had delirium/acute confusional episodes as the first symptoms. There was a clear tendency for patients with DLB to have two or more non-cognitive symptoms in the prodromal phase, such as delusion and rapid eye movement sleep behavior disorder (RBD). Overall, no evidence supported a high prevalence of the three subtypes of prodromal DLB. Additionally, findings suggest that an RBD subtype may exist, but more research is needed. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.
