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Letters to the Editor
December 2000

Visual Hallucinations and Dementia With Lewy Bodies

Arch Neurol. 2000;57(12):1792. doi:

We noted with interest the article "Diagnostic Criteria of Dementia With Lewy Bodies" by Hohl et al.1 We recently reported2 a meta-analysis of over 300 cases with clinical data and autopsy confirmation of dementia with Lewy bodies (DLB). Our findings agreed with the conclusion that "the diagnostic accuracy of DLB is poor." The most common diagnostic features in our study were parkinsonism (64%) and its co-occurrence with dementia (66%), findings consistent with the results of Hohl et al. Similarly, we found that only a small minority of cases had cognitive fluctuations. The major difference in results concerns visual hallucinations, which were observed in 100% of the patients of Hohl et al and in only 39% of our sample. We determined that visual hallucinations appear almost twice as frequently in patients who are receiving dopaminergic drugs; it is unclear how much of a role these agents played in the data of Hohl and colleagues. It is clear that the Consensus Criteria for DLB may require major revision and that more prospective clinicopathological correlation studies should be performed.

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