The Evolution of Symptoms in Prodromal Dementia With Lewy Bodies: A Naturalistic History Study in a Chinese Memory Clinic

ABSTRACT Objectives Given that DLB is the second most common neurodegenerative dementia and early detection is crucial, this study sought to delineate the pre‐diagnostic symptom evolution in patients from a Chinese memory clinic. Methods Prospective patients diagnosed with probable DLB ( n = 47, mean age at first symptom 71 years) registered at Dementia Care and Research Center, Peking University Institute of Mental Health were included. A dementia specialist performed data collection, medical history, and examination. We used the unified data form to prospectively collect the data at examinations every 3–6 months. In addition, retrospective data were extracted from medical records to identify the evolution of symptoms before diagnosis, including the first‐onset symptom(s) and the time elapsed before diagnosis. Results Most informants ( n = 36, 76.6%) reported only one initial symptom. The most frequently reported initial symptom was memory decline (57.4%). Throughout the journey to a diagnosis, the most common symptom was visual hallucination ( n = 29, 61.7%), followed by sleep problems and systematized delusions (both n = 20, 42.6%). Anxiety was the earliest recognizable individual psychiatric symptom of DLB, occurring an average of 73 months before diagnosis, followed by depression, memory decline (34 months before diagnosis), RBD, hallucinations and delusions, and motor symptoms of about 15 months before diagnosis. Fluctuating cognition, delirium, and impulsive aggressive behavior were documented relatively shortly before the diagnosis. Conclusions Cognitive and emotional symptoms were the most common early symptoms before a diagnosis of DLB. The findings are informative for the early detection of DLB.