Key takeaways:

  • UCL researchers reviewed new biomarkers for diagnosing Dementia with Lewy Bodies (DLB).
  • DLB is the second most common dementia, often misdiagnosed.
  • New tests detect misfolded α-synuclein in spinal fluid with high accuracy.
  • Advanced MRI and blood tests help distinguish DLB from Alzheimer’s.
  • More research is needed before these biomarkers are widely used.

A review led by researchers at Queen Square Institute of Neurology at University College London, has outlined the discovery and development of new diagnostic biomarkers for dementia with Lewy bodies (DLB).

The review was published in The Lancet Neurology and uncovered biomarkers from imaging and fluid analysis. The authors hope that the discovery could revolutionise the diagnosis process for DLB patients.

Senior Author on the paper, Rimona Weil said: “Our review shows that new biomarkers, some already available in research settings, could transform clinical practice. By combining multiple biomarkers to create personalised profiles for patients, this could enable earlier diagnosis, better monitoring, and more targeted treatments.

Dementia with Lewy Bodies

DLB is the second most common form of dementia after Alzheimer's disease, making up as much as 24% of dementia cases.

Diagnosis of DLB can be tricky and inexact due to the lack of biological markers associated with the disease. Instead, clinicians rely on symptomatic history and assessment data to make their judgement. These symptoms are shared by other forms of neurodegeneration like Alzheimer's or Parkinson’s disease and therefore can lead to misdiagnosis.

The prospect of new diagnostic biomarkers for DLB could radically change the experience of those suffering from the disease. Understanding the exact indication that the patient has can better inform treatment options and expedite care.

New biomarkers

Analysis of DLB patients’ cerebrospinal fluid was able to detect misfolded α-synuclein, a key protein implicated in the formation Lewy bodies. The team showed these tests to be up to 95% sensitive with a specificity of 98% for Lewy body pathology.

Furthermore, the paper accounts how the team could distinguish DLB from Alzheimer’s disease and monitor progression using advanced MRI techniques. It details the use of free water imaging, neuromelanin-sensitive MRI, and iron-sensitive approaches such as quantitative susceptibility mapping.

Analysis of the blood was also able to return useful DLB-related markers including extracellular vesicles. The team posits that multimodal approaches combining imaging and fluid tests could make diagnosis faster and more accessible worldwide.

Future research needed

The team also noted that further research was required to fully validate their findings but remained optimistic about the direction of the field.

First Author, Angeliki Zarkali said: “Currently there is a lack of evidence for the use of biomarkers for DLB disease progression, and this evidence will require large-scale, long-term studies to validate accuracy.

“There are also practical challenges such as cost, accessibility, and the need for specialist equipment. Once these challenges have been overcome, there is a lot of promise for these biomarkers.”

Looking forward, Weil said: “These innovations could accelerate the development of disease-modifying therapies helping people living with dementia with Lewy bodies and their families.”