[Longitudinal follow-up in patients with dementia with Lewy bodies: clinical and multimodal imaging characteristics].

Objective: To characterize the clinical and imaging features of Dementia with Lewy Bodies (DLB) through long-term follow-up. Methods: This study analyzed clinical and multimodal imaging data, including magnetic resonance imaging (MRI), dopamine transporter (DAT), 11C Pittsburgh compound B (11C-PIB), and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), from 11 probable DLB patients at the first and second medical center of PLA General Hospital from March 2012 to February 2025. Patients were longitudinally assessed for the following parameters: time from disease onset to bedridden status, time from onset to death, annual cognitive decline rate (measured by mini-mental state examination, MMSE), extent of cerebral atrophy, regions of hypometabolism, and areas of reduced DAT availability. A centralized telephone follow-up was conducted in February 2025 for all surviving cases. Results: A total of 11 DLB patients (9 males, 2 females) were included. The age at onset was (74.64±9.67) years, with (5.90±3.46) years follow-up. MMSE scores declined annually by (5.19±2.73) points. Time from onset to bedridden status was (4.87±1.47) years, and to death was (7.06±4.09) years. All patients had memory impairment; 2 showed attention/executive deficits. Cognitive fluctuations occurred in 7 cases. Visual hallucinations were present in 10 patients, and RBD in 7 (onset 4.30 [0, 14.00] years pre-diagnosis). Parkinsonism was seen in 10 patients: bradykinesia and rigidity in 9 (9/10) each, resting tremor in 5 (5/10). MRI showed early bilateral temporoparietal junction atrophy (6/11) with medial temporal lobe sparing. FDG-PET revealed temporoparietooccipital hypometabolism (10/11), progressing to frontal lobe involvement. The posterior cingulate cortex was relatively preserved, while the lateral occipital cortex and precuneus showed distinct hypometabolism. DAT-PET indicated reduced uptake in all cases. PIB-PET was positive in all: diffuse retention in 6, temporoparietal frontal cortex in 4, and frontal/occipital lobes in 1. Conclusions: DLB progresses rapidly with subtle early symptoms, contributing to high misdiagnosis rates. However, integrating detailed clinical assessment with multimodal neuroimaging enhances early differential diagnosis. Longitudinal follow-up in this cohort offers valuable insights into disease progression and prognosis.