lewy body disease

Summary

Summary: A neurodegenerative disease characterized by dementia, mild parkinsonism, and fluctuations in attention and alertness. The neuropsychiatric manifestations tend to precede the onset of bradykinesia, MUSCLE RIGIDITY, and other extrapyramidal signs. DELUSIONS and visual HALLUCINATIONS are relatively frequent in this condition. Histologic examination reveals LEWY BODIES in the CEREBRAL CORTEX and BRAIN STEM. SENILE PLAQUES and other pathologic features characteristic of ALZHEIMER DISEASE may also be present. (From Neurology 1997;48:376-380; Neurology 1996;47:1113-1124)

Top Publications

  1. Overk C, Masliah E. Pathogenesis of synaptic degeneration in Alzheimer's disease and Lewy body disease. Biochem Pharmacol. 2014;88:508-16 pubmed publisher
  2. Fujishiro H, Iseki E, Nakamura S, Kasanuki K, Chiba Y, Ota K, et al. Dementia with Lewy bodies: early diagnostic challenges. Psychogeriatrics. 2013;13:128-38 pubmed publisher
    ..these symptomatic but non-demented individuals that led us to suspect the underlying pathophysiology of Lewy body disease. Further prospective study is warranted to determine the clinical significance of LB-related symptoms in non-..
  3. Lin M, Cantuti Castelvetri I, Zheng K, Jackson K, Tan Y, Arzberger T, et al. Somatic mitochondrial DNA mutations in early Parkinson and incidental Lewy body disease. Ann Neurol. 2012;71:850-4 pubmed publisher
    ..To address this issue, we studied early stage PD cases and cases of incidental Lewy body disease (ILBD), which is thought to represent presymptomatic PD...
  4. Wennström M, Londos E, Minthon L, Nielsen H. Altered CSF orexin and ?-synuclein levels in dementia patients. J Alzheimers Dis. 2012;29:125-32 pubmed publisher
    ..Alterations in CSF orexin and ?-synuclein levels may be related to gender which warrants further investigation...
  5. Cersosimo M, Benarroch E. Pathological correlates of gastrointestinal dysfunction in Parkinson's disease. Neurobiol Dis. 2012;46:559-64 pubmed publisher
    ..in the enteric nervous system (ENS) and dorsal motor nucleus of the vagus (DMV) both in PD and in incidental Lewy body disease (ILBD)...
  6. Tateno F, Sakakibara R, Kawai T, Kishi M, Murano T. Alpha-synuclein in the cerebrospinal fluid differentiates synucleinopathies (Parkinson Disease, dementia with Lewy bodies, multiple system atrophy) from Alzheimer disease. Alzheimer Dis Assoc Disord. 2012;26:213-6 pubmed publisher
  7. Masliah E, Rockenstein E, Mante M, Crews L, Spencer B, Adame A, et al. Passive immunization reduces behavioral and neuropathological deficits in an alpha-synuclein transgenic model of Lewy body disease. PLoS ONE. 2011;6:e19338 pubmed publisher
    ..These results suggest that passive immunization with monoclonal antibodies against the CT of ?-syn may be of therapeutic relevance in patients with PD and DLB...
  8. Taylor J, Firbank M, Barnett N, Pearce S, Livingstone A, Mosimann U, et al. Visual hallucinations in dementia with Lewy bodies: transcranial magnetic stimulation study. Br J Psychiatry. 2011;199:492-500 pubmed publisher
    ..02). Increased visual cortical excitability in dementia with Lewy bodies does not appear to explain visual hallucinations but it may be a marker for their severity. ..
  9. Prasad K, Beach T, Hedreen J, Richfield E. Critical role of truncated ?-synuclein and aggregates in Parkinson's disease and incidental Lewy body disease. Brain Pathol. 2012;22:811-25 pubmed publisher
    ..Findings differed between incidental Lewy body disease and PD only quantitatively...

More Information

Publications62

  1. Setó Salvia N, Pagonabarraga J, Houlden H, Pascual Sedano B, Dols Icardo O, Tucci A, et al. Glucocerebrosidase mutations confer a greater risk of dementia during Parkinson's disease course. Mov Disord. 2012;27:393-9 pubmed publisher
  2. Auning E, Rongve A, Fladby T, Booij J, Hortobagyi T, Siepel F, et al. Early and presenting symptoms of dementia with lewy bodies. Dement Geriatr Cogn Disord. 2011;32:202-8 pubmed publisher
    ..To explore the presenting and early symptoms of dementia with Lewy bodies (DLB)...
  3. Tanji K, Mori F, Kakita A, Takahashi H, Wakabayashi K. Alteration of autophagosomal proteins (LC3, GABARAP and GATE-16) in Lewy body disease. Neurobiol Dis. 2011;43:690-7 pubmed publisher
    ..In this study, we determined whether Atg8 homologues are affected in Lewy body disease, including Parkinson's disease (PD) and dementia with Lewy bodies (DLB)...
  4. Compta Y, Parkkinen L, O Sullivan S, Vandrovcova J, Holton J, Collins C, et al. Lewy- and Alzheimer-type pathologies in Parkinson's disease dementia: which is more important?. Brain. 2011;134:1493-1505 pubmed publisher
    ..Cortical amyloid-? and age at disease onset seem to determine the rate to dementia...
  5. Mollenhauer B, Locascio J, Schulz Schaeffer W, Sixel Döring F, Trenkwalder C, Schlossmacher M. ?-Synuclein and tau concentrations in cerebrospinal fluid of patients presenting with parkinsonism: a cohort study. Lancet Neurol. 2011;10:230-40 pubmed publisher
    ..We aimed to assess whether reduction of ?-synuclein concentrations in CSF was a marker for ?-synuclein deposition in the brain, and therefore diagnostic of synucleinopathies...
  6. Meeus B, Theuns J, Van Broeckhoven C. The genetics of dementia with Lewy bodies: what are we missing?. Arch Neurol. 2012;69:1113-8 pubmed publisher
    Dementia with Lewy bodies is a complex brain disorder and a key member of the Lewy body disease spectrum. Its genetic etiology is unclear, and information is scattered...
  7. Tsuang D, Leverenz J, Lopez O, Hamilton R, Bennett D, Schneider J, et al. GBA mutations increase risk for Lewy body disease with and without Alzheimer disease pathology. Neurology. 2012;79:1944-50 pubmed publisher
    ..Parkinson disease (PD) and are a well-established susceptibility factor for PD, which is characterized by Lewy body disease (LBD) neuropathologic changes (LBDNCs)...
  8. Sinha N, Firbank M, O Brien J. Biomarkers in dementia with Lewy bodies: a review. Int J Geriatr Psychiatry. 2012;27:443-53 pubmed publisher
    ..Our aim was to review the literature to identify potential biomarkers that may distinguish DLB from other dementia subtypes, especially AD...
  9. Gaig C, Valldeoriola F, Gelpi E, Ezquerra M, Llufriu S, Buongiorno M, et al. Rapidly progressive diffuse Lewy body disease. Mov Disord. 2011;26:1316-23 pubmed publisher
    ..Lewy body syndromes (mainly Parkinson's disease and dementia with Lewy bodies) share many clinical features and usually have a slowly progressive course. Some patients may show rapid symptoms progression...
  10. Goedert M, Spillantini M, Del Tredici K, Braak H. 100 years of Lewy pathology. Nat Rev Neurol. 2013;9:13-24 pubmed publisher
    ..In this article, we review the relevance of Lewy's discovery 100 years ago for the current understanding of PD and related disorders...
  11. Boot B, Orr C, Ahlskog J, Ferman T, ROBERTS R, Pankratz V, et al. Risk factors for dementia with Lewy bodies: a case-control study. Neurology. 2013;81:833-40 pubmed publisher
    ..To determine the risk factors associated with dementia with Lewy bodies (DLB)...
  12. Walker L, LeVine H. Corruption and spread of pathogenic proteins in neurodegenerative diseases. J Biol Chem. 2012;287:33109-15 pubmed
    ..Impeding this process could represent a unified therapeutic strategy for slowing the progression of a wide range of currently intractable disorders...
  13. Irwin D, White M, Toledo J, Xie S, Robinson J, Van Deerlin V, et al. Neuropathologic substrates of Parkinson disease dementia. Ann Neurol. 2012;72:587-98 pubmed publisher
    ..A study was undertaken to examine the neuropathological substrates of cognitive dysfunction and dementia in Parkinson disease (PD)...
  14. Franciotti R, Falasca N, Bonanni L, Anzellotti F, Maruotti V, Comani S, et al. Default network is not hypoactive in dementia with fluctuating cognition: an Alzheimer disease/dementia with Lewy bodies comparison. Neurobiol Aging. 2013;34:1148-58 pubmed publisher
    ..69; p < 0.01). Causal flow analysis showed differences between patients with DLB and AD and control subjects...
  15. Wennström M, Surova Y, Hall S, Nilsson C, Minthon L, Bostrom F, et al. Low CSF levels of both ?-synuclein and the ?-synuclein cleaving enzyme neurosin in patients with synucleinopathy. PLoS ONE. 2013;8:e53250 pubmed publisher
  16. Price D, Rockenstein E, Ubhi K, Phung V, MacLean Lewis N, Askay D, et al. Alterations in mGluR5 expression and signaling in Lewy body disease and in transgenic models of alpha-synucleinopathy--implications for excitotoxicity. PLoS ONE. 2010;5:e14020 pubmed publisher
    ..These results highlight the therapeutic importance of mGluR5 antagonists in alpha-synucleinopathies...
  17. Games D, Seubert P, Rockenstein E, Patrick C, Trejo M, Ubhi K, et al. Axonopathy in an ?-synuclein transgenic model of Lewy body disease is associated with extensive accumulation of C-terminal-truncated ?-synuclein. Am J Pathol. 2013;182:940-53 pubmed publisher
    ..These results show that neuritic dystrophy is a prominent pathologic feature of the mThy1-?-syn tg model and suggest that CT ?-syn might play an important role in the process of axonal damage in these mice as well as in DLB and PD...
  18. Chiba Y, Fujishiro H, Iseki E, Ota K, Kasanuki K, Hirayasu Y, et al. Retrospective survey of prodromal symptoms in dementia with Lewy bodies: comparison with Alzheimer's disease. Dement Geriatr Cogn Disord. 2012;33:273-81 pubmed publisher
    ..Non-motor symptoms are recognized to enable the early detection of Parkinson's disease (PD). It remains unknown when those symptoms appear in dementia with Lewy bodies (DLB)...
  19. Kurzawa Akanbi M, Hanson P, Blain P, Lett D, McKeith I, Chinnery P, et al. Glucocerebrosidase mutations alter the endoplasmic reticulum and lysosomes in Lewy body disease. J Neurochem. 2012;123:298-309 pubmed publisher
    b>Lewy body disease (LBD) development is enhanced by mutations in the GBA gene coding for glucocerebrosidase (GCase)...
  20. Vekrellis K, Xilouri M, Emmanouilidou E, Rideout H, Stefanis L. Pathological roles of ?-synuclein in neurological disorders. Lancet Neurol. 2011;10:1015-25 pubmed publisher
    ..Consequently, factors that regulate the levels, post-translational modifications, specific aberrant cellular effects, or secretion of ?-synuclein might be targets for therapy...
  21. Bae E, Lee H, Rockenstein E, Ho D, Park E, Yang N, et al. Antibody-aided clearance of extracellular ?-synuclein prevents cell-to-cell aggregate transmission. J Neurosci. 2012;32:13454-69 pubmed
    ..These findings provide an underlying mechanistic basis for immunotherapy for PD/DLB and suggest extracellular forms of ?-synuclein as potential therapeutic targets...
  22. Galvin J, Price J, Yan Z, Morris J, Sheline Y. Resting bold fMRI differentiates dementia with Lewy bodies vs Alzheimer disease. Neurology. 2011;76:1797-803 pubmed publisher
    ..We performed resting state blood oxygen level-dependent (BOLD) functional connectivity MRI (fcMRI) to determine whether there were differences between AD and DLB...
  23. Stefani A, Brusa L, Olivola E, Pierantozzi M, Martorana A. CSF and clinical hallmarks of subcortical dementias: focus on DLB and PDD. J Neural Transm (Vienna). 2012;119:861-75 pubmed publisher
    ..However, more complete data, possibly collected in fieri during the progressive derangement of cognitive abilities, are needed to improve our ability to decipher and treat these entities...
  24. Kantarci K, Ferman T, Boeve B, Weigand S, Przybelski S, Vemuri P, et al. Focal atrophy on MRI and neuropathologic classification of dementia with Lewy bodies. Neurology. 2012;79:553-60 pubmed publisher
    ..To determine the association between the focal atrophy measures on antemortem MRI and postmortem neuropathologic classification of dementia with Lewy bodies (DLB) using the Third Report of the DLB Consortium criteria...
  25. Montine T, Phelps C, Beach T, Bigio E, Cairns N, Dickson D, et al. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease: a practical approach. Acta Neuropathol. 2012;123:1-11 pubmed publisher
    ..neuritic plaques (C), and (3) more detailed approaches for assessing commonly co-morbid conditions such as Lewy body disease, vascular brain injury, hippocampal sclerosis, and TAR DNA binding protein (TDP)-43 immunoreactive ..
  26. De Boni L, Tierling S, Roeber S, Walter J, Giese A, Kretzschmar H. Next-generation sequencing reveals regional differences of the ?-synuclein methylation state independent of Lewy body disease. Neuromolecular Med. 2011;13:310-20 pubmed publisher
    The ?-synuclein gene (SNCA) plays a major role in the aetiology of Lewy body disease (LBD) including Parkinson's disease (PD). Point mutations and genetic alterations causing elevated gene expression are causally linked to familial PD...
  27. Desai Bradaric B, Patel A, Schneider J, Carvey P, Hendey B. Evidence for angiogenesis in Parkinson's disease, incidental Lewy body disease, and progressive supranuclear palsy. J Neural Transm (Vienna). 2012;119:59-71 pubmed publisher
    ..Tissues were also obtained from subjects with incidental Lewy body disease (iLBD) who had Lewy bodies in the substantia nigra pars compacta (SN(pc)) but had not been diagnosed with PD,..
  28. Lebedev A, Westman E, Beyer M, Kramberger M, Aguilar C, Pirtosek Z, et al. Multivariate classification of patients with Alzheimer's and dementia with Lewy bodies using high-dimensional cortical thickness measurements: an MRI surface-based morphometric study. J Neurol. 2013;260:1104-15 pubmed publisher
    ..Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the most common neurodegenerative dementia types. It is important to differentiate between them because of the differences in prognosis and treatment approaches...
  29. Kantarci K, Lowe V, Boeve B, Weigand S, Senjem M, Przybelski S, et al. Multimodality imaging characteristics of dementia with Lewy bodies. Neurobiol Aging. 2012;33:2091-105 pubmed publisher
    ..Occipital and posterior parietotemporal lobe hypometabolism is a distinguishing feature of DLB and this regional hypometabolic pattern is independent of the amyloid pathology...
  30. Colloby S, Taylor J, Davison C, Lloyd J, Firbank M, McKeith I, et al. Multivariate spatial covariance analysis of 99mTc-exametazime SPECT images in dementia with Lewy bodies and Alzheimer's disease: utility in differential diagnosis. J Cereb Blood Flow Metab. 2013;33:612-8 pubmed publisher
    ..86, sensitivity 80%, specificity 80%). Multivariate analysis of blood flow SPECT data appears to be robust and shows good diagnostic accuracy in two independent cohorts for distinguishing DLB from AD...
  31. Treglia G, Cason E, Stefanelli A, Cocciolillo F, Di Giuda D, Fagioli G, et al. MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis. Clin Auton Res. 2012;22:43-55 pubmed publisher
  32. Boeve B. Mild cognitive impairment associated with underlying Alzheimer's disease versus Lewy body disease. Parkinsonism Relat Disord. 2012;18 Suppl 1:S41-4 pubmed publisher
    ..in patients with mild cognitive impairment (MCI) associated with underlying Alzheimer's disease (AD) versus Lewy body disease (LBD) pathology...
  33. Maetzler W, Stapf A, Schulte C, Hauser A, Lerche S, Wurster I, et al. Serum and cerebrospinal fluid uric acid levels in lewy body disorders: associations with disease occurrence and amyloid-? pathway. J Alzheimers Dis. 2011;27:119-26 pubmed publisher
    ..Taken together, our results provide first evidence for disease-relevant but potentially distinct roles of UA in the blood and CSF compartment, respectively, in LBD...
  34. Cullen V, Sardi S, Ng J, Xu Y, Sun Y, Tomlinson J, et al. Acid ?-glucosidase mutants linked to Gaucher disease, Parkinson disease, and Lewy body dementia alter ?-synuclein processing. Ann Neurol. 2011;69:940-53 pubmed publisher
    ..A loss in lysosomal acid-?-glucosidase enzyme (GCase) activity due to biallelic GBA1 mutations underlies Gaucher disease. We explored mechanisms for the gene's association with increased synucleinopathy risk...
  35. Luk K, Kehm V, Zhang B, O BRIEN P, Trojanowski J, Lee V. Intracerebral inoculation of pathological ?-synuclein initiates a rapidly progressive neurodegenerative ?-synucleinopathy in mice. J Exp Med. 2012;209:975-86 pubmed publisher
    ..These findings open up new avenues for understanding the progression of PD and for developing novel therapeutics...
  36. Obi K, Akiyama H, Kondo H, Shimomura Y, Hasegawa M, Iwatsubo T, et al. Relationship of phosphorylated alpha-synuclein and tau accumulation to Abeta deposition in the cerebral cortex of dementia with Lewy bodies. Exp Neurol. 2008;210:409-20 pubmed publisher
    ..The procession from Abeta to neurite pathology in the cerebral cortex of AD and DLB may be unifiable...
  37. Gloeckner S, Meyne F, Wagner F, Heinemann U, Krasnianski A, Meissner B, et al. Quantitative analysis of transthyretin, tau and amyloid-beta in patients with dementia. J Alzheimers Dis. 2008;14:17-25 pubmed
    ..A significant negative correlation of TTR CSF levels and disease severity in AD was observed...
  38. Spies P, Melis R, Sjögren M, Rikkert M, Verbeek M. Cerebrospinal fluid alpha-synuclein does not discriminate between dementia disorders. J Alzheimers Dis. 2009;16:363-9 pubmed publisher
    ..We conclude that in clinically diagnosed patients, alpha-synuclein does not appear to be a useful biomarker for the differentiation between DLB and other types of dementia...
  39. Beach T, Adler C, Lue L, Sue L, Bachalakuri J, Henry Watson J, et al. Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. Acta Neuropathol. 2009;117:613-34 pubmed publisher
    ..autopsied subjects included elderly subjects with Parkinson's disease, dementia with Lewy bodies, incidental Lewy body disease and Alzheimer's disease with Lewy bodies, as well as comparison groups without Lewy bodies...
  40. Yamamoto T, Kobayashi Y, Murata M. Risk of pneumonia onset and discontinuation of oral intake following videofluorography in patients with Lewy body disease. Parkinsonism Relat Disord. 2010;16:503-6 pubmed publisher
    We investigated the time course of pneumonia onset and duration of continued oral intake following videofluorography (VFG) in patients with Lewy body disease.
  41. Qing H, Zhang Y, Deng Y, McGeer E, McGeer P. Lrrk2 interaction with alpha-synuclein in diffuse Lewy body disease. Biochem Biophys Res Commun. 2009;390:1229-34 pubmed publisher
    ..are the leading cause of genetically inherited Parkinson's disease (PD) and its more severe variant diffuse Lewy body disease (DLB). Pathological mutations in Lrrk2 are autosomal dominant, suggesting a gain of function...
  42. Lucetti C, Logi C, Del Dotto P, Berti C, Ceravolo R, Baldacci F, et al. Levodopa response in dementia with lewy bodies: a 1-year follow-up study. Parkinsonism Relat Disord. 2010;16:522-6 pubmed publisher
    ..To evaluate levodopa responsiveness in patients with probable dementia with Lewy bodies (DLB) compared to early Parkinson's disease (PD) patients...
  43. Macinnes N, Iravani M, Perry E, Piggott M, Perry R, Jenner P, et al. Proteasomal abnormalities in cortical Lewy body disease and the impact of proteasomal inhibition within cortical and cholinergic systems. J Neural Transm (Vienna). 2008;115:869-78 pubmed publisher
    ..These findings suggest that proteasomal abnormalities are present within cortical Lewy body disease and the experimental inhibition of proteasomal function mirrors the neuropathological changes seen within ..
  44. Bonanni L, Thomas A, Tiraboschi P, Perfetti B, Varanese S, Onofrj M. EEG comparisons in early Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease with dementia patients with a 2-year follow-up. Brain. 2008;131:690-705 pubmed publisher
  45. Fujishiro H, Iseki E, Higashi S, Kasanuki K, Murayama N, Togo T, et al. Distribution of cerebral amyloid deposition and its relevance to clinical phenotype in Lewy body dementia. Neurosci Lett. 2010;486:19-23 pubmed publisher
    ..These results suggest that amyloid deposition may contribute to the timing of the onset of dementia relative to that of parkinsonism in Lewy body dementia...
  46. Lin W, Castanedes Casey M, Dickson D. Transactivation response DNA-binding protein 43 microvasculopathy in frontotemporal degeneration and familial Lewy body disease. J Neuropathol Exp Neurol. 2009;68:1167-76 pubmed publisher
    ..brains of patients with frontotemporal lobar degeneration with ubiquitin-positive inclusions and familial Lewy body disease. The TDP-43 immunohistochemistry revealed small round structures closely associated with small blood vessels...
  47. Kovari E, Horvath J, Bouras C. Neuropathology of Lewy body disorders. Brain Res Bull. 2009;80:203-10 pubmed publisher
    ..The recent progress of neuropathology in this field made it possible to define clinical and neuropathological guidelines for the diagnosis. This review briefly describes the most important data of all Lewy body related disorders...
  48. Maetzler W, Michelis J, Tomiuk J, Melms A, Becker C, Gasser T, et al. A single-nucleotide polymorphism of the osteopontin gene may contribute to a susceptibility to Lewy body disease. J Neural Transm (Vienna). 2009;116:599-605 pubmed publisher
    In Lewy body disease, inflammation is discussed to be involved in the pathophysiological cascade. Osteopontin (OPN) is a multifunctional molecule, which is increased in inflammatory states...
  49. Shinagawa S, Adachi H, Toyota Y, Mori T, Matsumoto I, Fukuhara R, et al. Characteristics of eating and swallowing problems in patients who have dementia with Lewy bodies. Int Psychogeriatr. 2009;21:520-5 pubmed publisher
    ..However, few systematic studies have investigated eating problems in DLB patients. The aim of this study was to clarify the frequency and characteristics of eating problems in patients with DLB...
  50. Paleologou K, Kragh C, Mann D, Salem S, Al Shami R, Allsop D, et al. Detection of elevated levels of soluble alpha-synuclein oligomers in post-mortem brain extracts from patients with dementia with Lewy bodies. Brain. 2009;132:1093-101 pubmed publisher
    ..Furthermore, these findings establish FILA-1 as a very sensitive tool for the detection of oligomeric forms of alpha-syn in human brain lysates...
  51. Beyer K, Domingo Sàbat M, Lao J, Carrato C, Ferrer I, Ariza A. Identification and characterization of a new alpha-synuclein isoform and its role in Lewy body diseases. Neurogenetics. 2008;9:15-23 pubmed
    ..Overexpression of alpha-synuclein 98 in LBD and AD brains would indicate its specific involvement in the pathogenesis of these neurodegenerative disorders...
  52. Reesink F, Lemstra A, van Dijk K, Berendse H, van de Berg W, Klein M, et al. CSF ?-synuclein does not discriminate dementia with Lewy bodies from Alzheimer's disease. J Alzheimers Dis. 2010;22:87-95 pubmed publisher
    ..05). Ultimately, CSF ?-synuclein was not a useful diagnostic biomarker to differentiate DLB and/or PD (?-synucleinopathies) from AD or SC. In DLB patients maybe lower CSF ?-synuclein levels are related to worse cognitive performance...
  53. Nishioka K, Wider C, Vilariño Güell C, Soto Ortolaza A, Lincoln S, Kachergus J, et al. Association of alpha-, beta-, and gamma-Synuclein with diffuse lewy body disease. Arch Neurol. 2010;67:970-5 pubmed publisher
    To determine the association of the genes that encode alpha-, beta-, and gamma-synuclein (SNCA, SNCB, and SNCG, respectively) with diffuse Lewy body disease (DLBD).