Dementia with Lewy bodies may present as dementia and REM sleep behavior disorder without parkinsonism or hallucinations

Tanis J. Ferman, Bradley F. Boeve, Glenn E. Smith, Michael H. Silber, John A. Lucas, Neill R. Graff-Radford, Dennis W. Dickson, Joseph E. Parisi, Ronald C. Petersen, Robert J. Ivnik

Research output: Contribution to journalArticlepeer-review

103 Scopus citations


Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disturbance that commonly occurs in Dementia with Lewy bodies (DLB). Retrospective examination of DLB course has shown that RBD and cognitive decline may precede the onset of parkinsonism and visual hallucinations. Therefore, some patients with DLB may initially present with dementia and RBD, but would not meet current formal criteria for probable DLB at that time. The purpose of this study is to determine whether patients with dementia and RBD, who do not have parkinsonism or visual hallucinations, have cognitive profiles that can be distinguished from autopsy-confirmed definite AD, but not from clinically probable DLB. If so, this would support the hypothesis that the presence of RBD and dementia, as the only presenting symptoms, reflects the early manifestation of DLB. Results show that early dementia in probable DLB and dementia with RBD are neuropsychologically indistinguishable. Both groups differ from definite AD of a similar early stage with significantly worse visual perceptual organization, sequencing and letter fluency but significantly better confrontation naming and verbal memory. In addition, follow-up data from a subset of patients with dementia and RBD reveal the subsequent development of parkinsonism or hallucinations 1 to 6 years later. Results indicate that the presentation of dementia and RBD is suggestive of underlying Lewy body disease and not Alzheimer's disease. This provides further evidence in support of including RBD as one of the core diagnostic features of DLB.

Original languageEnglish (US)
Pages (from-to)907-914
Number of pages8
JournalJournal of the International Neuropsychological Society
Issue number7
StatePublished - Nov 2002


  • Alzheimer's disease
  • Dementia with Lewy bodies
  • Lewy body disease
  • Parkinsonism
  • REM sleep behavior disorder
  • Visual hallucinations

ASJC Scopus subject areas

  • General Neuroscience
  • Clinical Psychology
  • Clinical Neurology
  • Psychiatry and Mental health


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