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

Objective: To explore the clinical features and dynamic changes of multimodal imaging in patients of Dementia with Lewy Bodies (DLB) through long-term follow-up. Methods: The clinical data of the suspected DBL patients who were admitted to the Neurology Department of the First and Second Centers of the PLA General Hospital from March 2012 to February 2025 were retrospectively collected. Descriptive methods were used to analyze the clinical features, head magnetic resonance imaging (MRI), dopamine transporter (DAT), 11C Pittsburgh compound B (¹¹C-PIB), and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET). The patients were followed up on time from disease onset to bedridden status, time from onset to death, annual cognitive decline rate, extent of cerebral atrophy, regions of hypometabolism, and areas of reduced DAT availability. The last follow-up was conducted in February 2025. 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. The Mini Mental State Examination(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 11 patients had memory impairment; 2 patients showed attention/executive deficits, and 7 patients had cognitive function fluctuations. Visual hallucinations were present in 10 patients, and rapid eye movement sleep behavior disorder (RBD) in 7 patients, which occured 4.30 (0, 14.00) years earlier than onset. 10 patients had Parkinsonism syndrome: bradykinesia and rigidity in 9 (9/10) each, resting tremor in 5 (5/10). MRI showed 6 patients had early bilateral temporoparietal junction atrophy with medial temporal lobe sparing. FDG-PET revealed 10 patients haddecreased metabolism in the parietal, temporal and occipital junction areas. With the progression of the disease, the FDG in the frontal lobe gradually decreased, and the metabolism in the posterior cingulate gyrus was relatively retained in the middle and late stages of the disease. DAT-PET indicated that all 11 patients presented with decreased DAT distribution in bilateral putamen or caudate nucleus. 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, clinical and multimodal imaging features with longitudinal follow-up can effectively assist in early differential diagnosis.