When should I consider referring a patient with suspected Dementia with Lewy Bodies to a specialist for further evaluation?

You should consider referring a patient with suspected Dementia with Lewy Bodies (DLB) to a specialist dementia diagnostic service, such as a memory clinic or community old age psychiatry service, once reversible causes of cognitive decline have been investigated and dementia is still suspected ¹,³.

Reversible causes of cognitive decline include delirium, depression, sensory impairment (such as sight or hearing loss), or cognitive impairment from medicines associated with increased anticholinergic burden ¹,³.

Once referred, specialist investigations for suspected dementia may include structural imaging (MRI or CT scan) ¹. If the diagnosis remains uncertain and DLB is suspected, the specialist may consider further tests such as ¹²³I-FP-CIT SPECT or ¹²³I-MIBG cardiac scintigraphy, particularly if knowing the dementia subtype would change management ¹,³.