Talk:Dementia with Lewy bodies/Archive 4

Duplinks
I forgot to run the duplink checker before promoting... I wouldn't have held up promotion over them but nonetheless I see there's a lot of them in there so pls review -- I daresay some will be justified in such an article but they'd be scope for rationalising. Cheers, Ian Rose (talk) 23:39, 31 May 2020 (UTC)
 * , where does one find this tool? Sandy Georgia (Talk)  11:17, 1 June 2020 (UTC)
 * Here. Cheers, Ian Rose (talk) 11:26, 1 June 2020 (UTC)
 * , thanks! I have reduced overlinking here, although I did leave several repeat links because of the complexity of the topic. Regards, Sandy Georgia  (Talk)  12:11, 1 June 2020 (UTC)

Automatic "typo"
thanks for the typo correction here, although it wasn't actually a typo-- it was the kind of intentional dumbing down of language in medical leads that we can probably do without, for the very reason you demonstrated! Sandy Georgia (Talk)  17:59, 1 September 2020 (UTC)
 * And another ... thank you so much, IP 67. How do we get this far in with no one else having seen that?  Sandy Georgia  (Talk)  03:19, 17 September 2020 (UTC)

SFN citations
Contemplating the ongoing MCOTM at tonsillitis, I confess that Spicy and Ajpolino may have convinced me. I figured out how to make all SFNs work, did a test here of one of each type (that is, one author, three authors, more than three authors with et al, one author with two publications in same year, and book with an editor and different chapters cited, as well as articles that have sections rather than page nos). I am able to easily make every possibility work. And I am convinced it is not so difficult, while easier on the reader. Does anyone have any thoughts as to whether I should convert? Bst, Sandy Georgia (Talk)  15:34, 3 November 2020 (UTC)
 * I had a look at your edit. The "Boot et al. 2013." citation doesn't have a page number visible. Even before your sfn change, in order to make the citation refer to a page number in a commonly used ref, you need to stick most of the journal references in a big block at the bottom, like List Defined Refs had. I thought you hated that and it was hard for newbies (visual editor) to deal with. Or can the visual editor detect that a source is used more than once but with different page numbers? -- Colin°Talk 15:59, 3 November 2020 (UTC)
 * Ah ha, eagle eye! The Boot error was because I mistakenly left the period after the p before the page number ... I tested and was able to fix that.   The "big block at the bottom" requires no change ... the article already has refbegin and refend.  I don't use the visual editor, so can't answer that ... but the article gets very few edits while very high pageviews ... and I have come to agree that SFN serves the reader here by getting them to the source in one click. But I think the answer to your question is that there is no problem with that. I may feel differently on a highly edited article.  Sandy Georgia  (Talk)  16:43, 3 November 2020 (UTC)
 * My point about the block of references isn't to do with sfn but the page number changes made in May. Back on the 16th May, the References section had only . Now it has a sub-section "Works cited" with 30 hand-inserted entries. I guess the difficulty is that in order to add a new source with page location, you need to add it to the section at the bottom and edit the section in the text with the page-number ref, and presumably ensure they both match. From the reader's POV, there are a couple of dozen references where you just include the full journal citation directly, rather than in two steps, and it probably isn't clear to them why. Do you have some threshold for max number of pages to cite? -- Colin°Talk 17:08, 3 November 2020 (UTC)
 * IT was (IIRC) somewhere around three to six ... but now that I know how to do it, I would probably convert those as well. The reason I did it then was I was afraid that looking up page numbers would be prohibitively difficult, but turns out that it was not. Because I could almost always look by section. Sandy Georgia (Talk)  18:03, 3 November 2020 (UTC)
 * I like the sfn format and support its use. Cas Liber (talk · contribs) 00:07, 4 November 2020 (UTC)

Done! My conclusion is that it's more readable, but I would not prefer this style on a more highly edited article. It works in this case because the article is highly viewed, but rarely edited. Sandy Georgia (Talk)  15:36, 4 November 2020 (UTC)

Move discussion in progress
There is a move discussion in progress on Talk:Lewy body dementia which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 20:03, 17 November 2020 (UTC)

Lead image
a new image was added to the lead by. This is a featured article that has not yet appeared at WP:TFA; since I "don't speak images", could you please doublecheck that File:Lewy body in the substantia nigra from a person with Parkinson's disease.jpg is compliant with WP:WIAFA? (Tulemo, when adding an image to a Featured article, it is recommended to first check on article talk-- see WP:FAOWN.) Sandy Georgia (Talk)  19:43, 9 February 2021 (UTC)
 * Thanks for your comments.
 * The new image of a Lewy body was prepared and submitted by me, and as far as I am aware is compliant. I felt that it was needed because the former photo was blurry, the Lewy bodies were not indicated in the image, and there was no scale bar. If you prefer the prior image, please feel free to revert.
 * Thanks, Tulemo; since I don’t speak images, I always need someone else to verify, and it is particularly important in this case as the article has not yet run TFA. Sandy Georgia (Talk)  23:28, 9 February 2021 (UTC)
 * Did you create this image yourself? Nikkimaria (talk) 00:48, 10 February 2021 (UTC)
 * Yes, as noted (Own Work) in Wikimedia Commons.
 * Okay, thanks. Sandy, this is correctly licensed according to the information provided; I can't comment on accuracy, representativeness, etc. Nikkimaria (talk) 03:22, 11 February 2021 (UTC)

Cocaine addiction
I have removed this series of edits by which: Tamacat2, please review WP:MEDRS, WP:MEDDATE, WP:WIAFA, WP:BRD and WP:OWN, and discuss your edits on talk before reinserting them. That (acronym soup) is a lot to digest, but you should before continuing to insert Synthesis and UNDUE material in to a featured article. Sandy Georgia (Talk)  14:10, 4 April 2021 (UTC)
 * use a 2003 primary source,
 * use synthesis of that source with other sources
 * use a dated (2014) review which has a brief mention of a 2009 very small sample, unreplicated primary study, which
 * contains content not mentioned in other recent high-quality secondary reviews, and
 * if mentioned in other sources might (although I doubt it) find a place at Lewy body but is WP:UNDUE here.

Pimavanserin
Rejected by FDA after Phase 3 trials: https://www.empr.com/home/news/drugs-in-the-pipeline/fda-rejects-pimavanserin-snda-for-dementia-related-psychosis/. Sandy Georgia (Talk)  21:59, 31 May 2021 (UTC)

Fluctuating cognition
Prior to the July 21 TFA, I wanted to beef up the emphasis on fluctuations in cognitive abilities, which is really a defining feature of the LBDs that I don't think I had spelled out clearly enough. perhaps you will check my changes for comprehensibility, and has been steadily chipping away at upgrading the text, so may want to look as well! Diff of changes. Thanks, Sandy Georgia (Talk)  16:03, 9 July 2021 (UTC)


 * Reaching somewhat here, could be wrong: "Fluctuation" or "fluctuations" can be used. The former meaning "constant change; vacillation; instability" and the latter "an irregular shifting back and forth". IMO the former sounds better.Lukelahood (talk) 22:21, 9 July 2021 (UTC)
 * The literature usually uses either fluctuating or fluctuations (see the two main sources specific to this topic as well as the McKeith consensus paper). But I am not a great copyeditor, so defer to you, Colin and others.  I also believe the concept in DLB to be more of a shifting back and forth … thanks for the help! Sandy Georgia  (Talk)  22:30, 9 July 2021 (UTC)
 * glad to throw some thought towards it... okay yeah the literature uses the plural form.Lukelahood (talk) 23:13, 9 July 2021 (UTC)
 * I'm not sure the text places the emphasis on this as "really a defining feature of the LBDs" or as this puts it, "long been recognized as the most characteristic feature of DLB (McKeith, 2002)". Merely saying it is "characteristic of the Lewy body dementias" or that it is among the core features, doesn't quite highlight it enough. We need to perhaps include an adjective somewhere, and/or else spell out that this feature isn't typical of other dementias (in other words, explain why the experts say it is "the most characteristic feature"). -- Colin°Talk 10:05, 10 July 2021 (UTC)
 * I will scan the other sources to see if I can find something that specifies that this characteristic distinguishes it from other dementias ... meanwhile, Lukelahood may also have a way to make this more specific. Thanks, Colin! Sandy Georgia  (Talk)  18:02, 10 July 2021 (UTC)

TFA
A big thanks to the two IPs who caught (quite) embarrassing typos, and to everyone who helped with the vandal reverts! I have made this cumulative edit to restore some minor items to the pre-TFA version. Please discuss.

This edit attempted to resolve a TFA kerfuffle, but I think we can do better. After quite a concerted effort (over several years and at several different venues and pages) to minimize jargon in a topic that is already technically dense, everyone involved in this article was reminded many times of the need to keep the lead-- and in particular the first paragraph, even more so the first sentence-- as accessible and jargon free as possible. So, in looking through the entire lead, we have the autonomic nervous system mentioned later in the lead, but with a link to dysautonomia (which is dysfunction in the autonomic nervous system). My solution is to correct both of the issues (keep the first sentence as simple as possible, while making a direct link to the autonomic nervous system later when it is mentioned). Diff of change. Please discuss; a good deal of effort went in to making sure the first sentence was as free of jargon as possible, and hopefully this is a new solution. Sandy Georgia (Talk)  12:44, 22 July 2021 (UTC)


 * I was happy to see the link added to Dysautonomia. WhatamIdoing (talk) 16:21, 22 July 2021 (UTC)
 * While "unconscious" is technically correct here, I suspect many readers will think "unconscious bodily functions" refers to things that happen when you sleep. I wonder if we can go back to "automatic bodily functions". The new link is perhaps slightly less likely to cause some Wikipedians to think we've made a typo or that we naively consider the two words are the same. -- Colin°Talk 17:18, 22 July 2021 (UTC)
 * Either word works for me, but would like to hear from more editors. Sandy Georgia (Talk)  17:25, 22 July 2021 (UTC)
 * , no one else has opined. I am off to bed, but unless someone has other ideas, you might change when you wake up (while I am still snoozing :) ??  Sandy Georgia  (Talk)  02:19, 23 July 2021 (UTC)
 * I agree with Colin. Adrian J. Hunter(talk•contribs) 05:33, 23 July 2021 (UTC)
 * Saving also this explanation, which I just saw. I inserted the change yesterday.  Sandy Georgia  (Talk)  12:57, 24 July 2021 (UTC)

No known cure
The article states There is no cure or medication to stop the disease from progressing. I can find no support for that in the citation after that statement. I twice tried to simply change that to "no known cure". As a general matter of science, we don't know if there is a helpful medication or cure. If we knew there wasn't, we wouldn't be doing research to find it! Treatments and medicines are being tested, formally and informally, all the time. It is not redundant to add the word "known" and thus note that a cure might exist. So I have made the change a third time and added a source. Before reverting, please discuss or give a reasonable explanation for your views. ★NealMcB★ (talk) 00:00, 25 October 2021 (UTC)


 * , please review the following pages:
 * WP:OWN
 * WP:WIAFA
 * WP:BRD
 * WP:EDITWAR
 * WP:LEAD
 * WP:MEDRS
 * You have not only introduced a redundancy three times; you have now also added a source to the lead of a featured article that is not compliant with Wikipedia’s WP:MEDRS sourcing guidelines. Please take care to read the pages above, the edit template that you can view each time you edit this featured article, and remember to discuss your edits before editwarring to reinstate them after they have been removed. 23 Oct 14.24, 24 Oct 21:56, 25 Oct 00.01. “Known” cure is redundant to cure, but more significantly, please take care not to use press releases from commercial sources for medical content. Leads do not need to be cited, but the citation for that content, found in the body of the artiicle and in the inline commentary, is Yamada 2020 and Tahami 2019 (see the first sentence in the Management section)— leads summarize the content as already cited in the body of the article. As of 2020, we firmly know that there is no treatment or medication that alters the relentless course of the disease, which has no cure.  Please build consensus for your proposed changes. Sandy Georgia  (Talk)  04:25, 25 October 2021 (UTC)
 * I understand the process, and I have expanded on the discussion each time, via edit comments rather than the slightly more time-consuming talk page. And I'm happy to do so here now that I have more of a sense for your concern. Re redundancy with the word "cure", I'd say for example that eating oranges has always been a cure for scurvy even though that wasn't widely known until the 1700's. I dare say that on the other hand there are other diseases for which a "cure" is so unlikely that it is not even worth researching, for which we could reasonably say there is "no cure". I certainly hope that is not true for DLB, but it is in that sense that I think the word "known" adds worthwhile context to both "cure" and "medicine". Can you point to a definition of "cure" which you think presumes the notion of being known? The one at Merriam Webster doesn't suggest it to me. My citation was simply meant to demonstrate one of several sources using the phrasing "no known cure" re DLB, and I think it should be easy to find an acceptable citation for that use. I note that "no known cure" occurs often in Wikipedia and elsewhere. In fact it appears in this article in the body: As of 2020, no cure is known for DLB.
 * I'll also note that the current sentence claims that there is "no ... medicine to stop the disease". I would again ask that we back off from that claim. Thank you for pointing to the Tahami 2019 quote (there are no medications available which will modify the course of disease), which does jive with the current phrasing, but I would say their text is also compatible with my simple proposed change. E.g. medications can exist but not be "available" for treatment since they aren't approved etc. At the same time, please know that I'm not trying to market some snake oil or inject wishful thinking here. If there is a cite on why medical evidence suggests that this particular disease is much less amenable to "cure", that would indeed be worth citing. Or if anyone is aware of ongoing research that is hopeful of finding a cure, that would support the use of "known". From what I've read, we are simply aware of no convincing evidence that any given medicine stops the disease, though many studies are presumably ongoing and, in general, many medicines have many beneficial effects that have not been noticed. ★NealMcB★ (talk) 04:59, 25 October 2021 (UTC)
 * Thank you for now properly engaging on talk. I hope you have become familiar now with all of the links I have added above, since using a commercial press release to cite medical content is never OK, and is really not OK for a featured article, or for the lead of a featured article. The lead has been worked over by a dozen or more editors and reviewers, which doesn't mean the wording can't be improved, but that should not be done via editwarring, rather discussion.  A lot of thought went into the wording, so discussion is appreciated rather than unilateral changes.   I have now added the "no cure" issue to the Prognosis section, as this discussion caused me to realize that we had mentioned it only in Management, but it also belongs in prognosis.   Wording can always be improved, but a lead has to be a brief summary of the main concepts.  We are trying to cover a lot of territory in one phrase ("There is no cure or medication to stop the disease from progressing") to summarize that there are no disease modifying treatments, cures, therapies or medications-- the disease will progress to death.  Sorry the facts can't be sugarcoated, not is it our job to do so.  Adding "known" to the lead is just cumbersome considering all that phrase is covering, but I did use that in the prognosis section if that helps.  Since the sources clearly state "there is no cure for DLB", I don't see the usefulness in beating that horse to death. Medical articles state facts; we can't really sugarcoat them, they are what they are. We don't have anything to back off on; we are reflecting sources which state that there is no cure and there are no treatments that will alter the progression. Perhaps  or, who are better wordsmiths than I am, can cut through the wording issue that concerns you; at one point, we had simply in the lead "There is no cure or medication that will modify the relentless progression of the disease."  I was in favor of the word relentless, but others were not. Sandy Georgia  (Talk)  05:18, 25 October 2021 (UTC)
 * re If there is a cite on why medical evidence suggests that this particular disease is much less amenable to "cure", that would indeed be worth citing, the entire article already explains this :) :) It's a very complex disease. Sandy Georgia (Talk)  05:27, 25 October 2021 (UTC)
 * I think it is encyclopaedic to state the facts as they are currently. There is no cure or treatment. A journalist covering research into possible cures or treatments will naturally want to hint that one may be just round the corner. And "no known cure" is cliched writing to say as much. Actually, it suggests that the cure may already exist, we just haven't found it yet. That may occasionally be true but most likely the drug has yet to be synthesised or procedure yet to be invented.
 * Go back to Jan 2020 and Covid 19 had no vaccine. It didn't have "no known vaccine", as though perhaps the Russians already had developed one and didn't tell us about it. That didn't stop us being full of hope that a vaccine would be developed, and, I believe, we've now ended up with more vaccines for it than any other single disease.
 * The article does make use of "as of", which MOS suggests should only be used if you think the information is likely to be soon out of date (such as the current population of a city). This informs the readers as to how recent this statement was last checked to be the case. -- Colin°Talk 07:56, 25 October 2021 (UTC)


 * Colin has explained the issue well and I have little to add. When I started researching rotaviruses in the 1970s, there was no vaccine. There wasn't an unknown one lying around waiting to be found. I had to spend a huge chunk of my life helping to invent one. Writing that there is no known cure implies that we are just ignorant of it, which is rarely the case in modern medicine. None of the HIV drugs that have changed a death sentence to a chronic well-managed condition were discovered; they were all invented. Graham Beards (talk) 08:19, 25 October 2021 (UTC)
 * Thank you all for your thoughtful engagement and rationales beyond the initial notion that the word "known" was redundant. And I appreciate your reasoning on not adding the word "known" to the short lede, and I'm glad to see it added to the body. Keep up the good work! ★NealMcB★ (talk) 22:24, 13 November 2021 (UTC)

The patient experience
I can't figure out in what section I would put this kind of information: Some of it fits here and there, but I (we) don't seem to have a section that reflects what the person with DLB lives, feels, experiences. Sandy Georgia (Talk)  20:59, 15 December 2021 (UTC)
 * CC-BY icon.svg Material was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.


 * Stevenfruitsmaak started a discussion at MEDMOS about this a couple of years ago. It's on the to-do list.  One suggestion was to create a ===Sub-section=== for it; another was to infuse the material across multiple existing sections (e.g., emotional response to diagnosis in ==Diagnosis==, experience of managing every day in ==Management==, views on prognosis in ==Prognosis==, etc.).  WhatamIdoing (talk) 06:20, 16 December 2021 (UTC)
 * I like those ideas … thx ! Sandy Georgia (Talk)  14:13, 16 December 2021 (UTC)

2021 update
There have been quite a few advancements in knowledge of DLB, and I have incorporated multiple 2021 reviews with these edits. Some of the new developments resulted in real changes to the article (better understanding of survival time after diagnosis, reflecting new knowledge of delay in diagnosis and the limits of the MMSE to detect cognitive fluctuations, which must be emphasized, and the deficits more common to DLB compared to AZ, along with a few medication updates and a new review about the lived experience, as well as some better wording based on the newer reviews). Note that Bentley is CC-by-4.0 so I was able to use some direct passages with attribution. Please have a look in case I have messed up anything :) Research has really accelerated since the 2017 consensus guidelines, and the 2020 guidelines recognizing the prodromal phase, so I will need to keep a closer eye on new research going forward; please let me know if you see anything! Best regards, Sandy Georgia  (Talk)  20:59, 16 December 2021 (UTC)

Incorrect license on Bentley ?
after Lukelahood pointed out (in the thread just above this one) CC by 4 on another source in this article, upon re-reading some old information from you, I am concerned that I may have done the Bentley additions wrong. The source (Bentley) is: I added the source to Works cited with CC by 4 attribution here, and copied text here, here, and here and then adjusted here. But upon re-examining Bentley, I don’t think I used the right license. Sandy Georgia (Talk)  08:27, 21 December 2021 (UTC)
 * https://onlinelibrary.wiley.com/doi/epdf/10.1111/jan.14932
 * Hi Sandy. If you hover over the words "Creative Commons Attribution" in the paper, you will see a hyperlink to the Attribution 4.0 International (CC BY 4.0) license. So it looks correct— Diannaa (talk) 11:39, 21 December 2021 (UTC)
 * Whew, thanks, . I must have done that when I was on my “real” computer, but since I am now iPad editing, and my iPad won’t hover, I couldn’t see the CC by 4, so wondered where the heck I had gotten it.  Sorry for the false alarm, Sandy Georgia  (Talk)  11:50, 21 December 2021 (UTC)

Possible good picture to put in article
,

What do you think about figure 1A in this creative commons licensed article? It is relevant to the text in Dementia_with_Lewy_bodies, Alzheimer subsection talking about hippocampus. Could be relevant elsewhere too.

Lukelahood (talk) 06:22, 21 December 2021 (UTC)
 * ummm … well … I had not realized that article was CC-by-4.0. All the time I spent paraphrasing with my dreadful prose, and I could have used more of the original wording (which I may go back and do now).  I like both 1A and 1B, but I defer to the image master, as my knowledge of images is worse than my prose.  Thanks for all your help!  Sandy Georgia  (Talk)  07:57, 21 December 2021 (UTC)
 * I went ahead and put three images in. Please let me know what you think. They all illustrate points made in the text (figure 1B didn't as far as I could tell...)Lukelahood (talk) 22:13, 23 December 2021 (UTC)
 * You are/they are wonderful! Just last week, I was casting about looking for images, and coming up with nothing.  I viewed the image layout on my desktop, iPad and iPhone, and changed up the layout to something that views better on the iPhone, as WAID tells us most people access articles these days via mobile devices.  If anyone finds it not optimal, we can switch back to your version.  Thank you ever so much, and may you have a joyous and healthful holiday! Sandy Georgia  (Talk)  23:45, 23 December 2021 (UTC)
 * works for me (I just read and work from desktop). Glad you like them. Happy holidays to you too.Lukelahood (talk) 00:08, 24 December 2021 (UTC)

Images removed
I have reverted here the addition of two images which are either dated or misleading: Sandy Georgia (Talk)  21:46, 24 January 2022 (UTC)
 * File:Epidemiology of dementia en.jpg is cited to a dated (2010) review of young onset dementia, . It's not applicable to this article, and I question whether it should be used anywhere (see WP:MEDDATE). We don't have an article on early-onset dementia, and if we did, I'm still not sure this data is up-to-date. With DLB, the best (indeed most) reviews never show a diagram relative to other dementias, as all recognize that we don't really know the prevalence as well as this diagram implies.  "Early-onset" DBL is almost never treated in the major reviews, so this image here is also WP:UNDUE.
 * The multiple image showing clozapine and mirtazapine is also unhelpful as UNDUE. Treatment of DLB symptoms is very complex, and adding those particular drugs to this article does not improve the article. The AChEIs have the best record with DLB, but even showing them would leave the wrong impression that DLB can easily be treated with meds.  Sandy Georgia  (Talk)  21:46, 24 January 2022 (UTC)


 * Another problem is that the image is labeled “Epidemiology of dementia” but sourced to a dated review of “early onset” dementia; the image is misleading. Sandy Georgia (Talk)  09:37, 25 January 2022 (UTC)
 * do you know how to get that grossly inaccurate image removed from Commons? If not, can the title be changed to indicate it relates to a ten-year old review of “early-onset” dementia only?   See my post at med talk. Sandy Georgia  (Talk)  09:51, 25 January 2022 (UTC)
 * your chart has 14% for "other" but the paper Sandy claims is the source has 19%. I know that if you add up the other segments you are left with 14% but this is because the other segments are rounded, and instead if you were to add up the raw figures, then I think 19% would be the correct value to show for "other". Can you please fix this and add the source to the file description page if Sandy is correct:
 * Also can you request the file name be changed to "Epidemiology of young-onset dementia en.jpg". If you need help with this let me know. If the file is not used on any Wikipedia, and we can't find a use for it (e.g. because the data is way too old) then it is possible for you (Pereoptic) to request it be deleted. It is harder for other users to request deletion simply on grounds of being uselessly out-of-date. Alternative, can you find newer data? -- Colin°Talk 13:15, 25 January 2022 (UTC)
 * SandyGeorgia: What you said about the statistics shown in the picture is correct. I did more research on the history of its statistics and found that even its history is older than 2010. I will do the more thorough investigation to see if there are any more up-to-date statistics. good luck  Pereoptic  Talk✉️  14:12, 25 January 2022 (UTC)
 * File has been moved to File:Epidemiology of young-onset dementia 2010 en.jpg -- Guerillero  Parlez Moi 16:01, 25 January 2022 (UTC)
 * Thanks, Guerillero.  my suggestion would be to request deletion.  is a newer source (still dated, perhaps someone can find newer still). Data from 2003 is just not helpful in this area. Sandy Georgia  (Talk)  16:29, 25 January 2022 (UTC)
 * SandyGeorgia: First I try to upload a new version based on the new statistics, if it is not adjustable on the same image, I will request deletion. Thanks for the link you sent. Pereoptic  Talk✉️  17:42, 25 January 2022 (UTC)
 * SandyGeorgia: First I try to upload a new version based on the new statistics, if it is not adjustable on the same image, I will request deletion. Thanks for the link you sent. Pereoptic  Talk✉️  17:42, 25 January 2022 (UTC)

improve the infobox
Hi SandyGeorgia, Hope you are well.

Do you think it is good to add the management section to the infobox? Pereoptic Talk✉️  11:23, 26 March 2022 (UTC)


 * Generally, I don't think it helpful to have an infobox at all, as they don't reflect nuance, can't typically reflect full or accurate information, and often convey misinformation. But, they are covered undered Arbom discretionary sanctions and we seem stuck with them in many cases following the arbitration. I usually opt for the least amount of information possible in them, to convey the least amount of misinformation. Medication is already in the infobox; what else did you want to add? I don't see how non-medication strategies can be stated in two or three words. Sandy Georgia  (Talk)  14:28, 26 March 2022 (UTC)
 * @SandyGeorgia: The part I intend to add to the infobox is the management of RBD symptoms and to some extent the management of orthostatic hypotension.
 * For example: use medication sensitivity notices, improve bedroom safety, lowering the height of the bed, Physiotherapy, avoiding alcohol Pereoptic  Talk✉️  06:00, 27 March 2022 (UTC)
 * That is excess detail for an infobox in my opinion. Not everyone has every symptom (DLB is different for everyone), and where do we draw the line on how much to include in the infobox? Why those few in particular when there are paragraphs of suggestions of things one can try to help with specific symptoms? The medications are more generalized. Sandy Georgia  (Talk)  14:09, 27 March 2022 (UTC)
 * @SandyGeorgia:Medications are also used to manage some of the symptoms, so should we eliminate them as well? Since RBD is a very common symptom of DLB, it is certainly a good idea to add its non-drug management method and some others, I mentioned in the answer above, to the infobox. Pereoptic  Talk✉️  07:15, 28 March 2022 (UTC)
 * You listed five things above you want to add to the infobox, for only RBD. There are multiple core symptoms of DLB; why only RBD?  Should we also add use compression stockings, organized activities, music therapy, physical activity and occupational therapy, exercise and gait training, cognitive behavioral therapy, avoiding meals high in fat and sugary foods, eating smaller and more frequent meals, after-meal walks, increasing fluids or dietary fiber, stool softeners, wear loose fitting clothing... where do we stop? Infoboxes are not designed for this purpose (and don't work well for even what they were designed for).  I don't object to deleting the infobox, to avoid having these very kinds of discussions. Sandy Georgia  (Talk)  08:05, 28 March 2022 (UTC)
 * @SandyGeorgia:The same goes for medicine. Memantine, dextroamphetamine, etc. And why RBD? Because it is common among people with DLB. My suggestion was not so important, Do whatever you think is best. But I think the management section can also be added to the infobox. Good luck Pereoptic  Talk✉️  11:36, 28 March 2022 (UTC)
 * The main treatments for DLB are the medications listed; the others are sometimes/maybe/sorta/kinda things to try. Infoboxes are not good for conveying any kind of information; that's why so many of us dislike them. Expanding them is not the solution; removing them and encouraging readers to read and digest nuance is. Sandy Georgia (Talk)  12:08, 28 March 2022 (UTC)

Life expectancy
re this edit, please have a look at WP:MEDRS, WP:FAOWN and WP:LEAD. Also, take a look at the Prognosis section of the article, where variability and greater detail is explored. I removed your edit because it added four citations to the lead, some non-MEDRS, without changing much other than providing a range around which the 2021 review number is based. LEADs are summaries of key points; we can't explore everything about life expectancy in the lead. Sandy Georgia (Talk)  18:46, 26 July 2022 (UTC)


 * Armstrong (2021) supports the variability text (already in the infobox and the article body), so I have added this text. Sandy Georgia (Talk)  18:52, 26 July 2022 (UTC)
 * Thank you! Likeanechointheforest (talk) 15:09, 27 July 2022 (UTC)
 * Likewise! Sandy Georgia (Talk)  16:22, 27 July 2022 (UTC)

Blood tests
The lead says: "A presumptive diagnosis can be made if several disease features are present, such as symptoms or certain results of blood tests, neuropsychological tests, imaging, and sleep studies."

But from the text it looks like blood tests are mainly used:
 * To rule out other conditions: "laboratory testing to rule out conditions that may cause symptoms similar to dementia, such as abnormal thyroid function, syphilis, HIV, and vitamin deficiencies."
 * In research: "Other tests to detect alpha-synuclein with blood tests are under study as of 2021."

Did I miss something? A455bcd9 (talk) 09:30, 12 December 2022 (UTC)


 * I have restored older wording, which morphed over time, confusingly as you pointed out! Thx, . Sandy Georgia  (Talk)  14:28, 12 December 2022 (UTC)
 * Thanks!
 * I also wonder:
 * "Since 2001, 123iodine-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy has been used diagnostically in East Asia (principally Japan),[40][135][136] but not in the US." => what about the rest of the world? And which countries in East Asia besides Japan? (China? South Korea? Taiwan?)
 * "Commercial skin biopsy tests for DLB are available in the US": since when? how much do they cost? I guess these tests were FDA approved, do we know how efficient they are? The following sentence ("the role of these tests in clinical practice has not been established") isn't clear (although the source doesn't say much more unfortunately...)
 * "the FDA has given a 'breakthrough device' authorization for CSF testing": when? (found this 2022 source but not RS)
 * A455bcd9 (talk) 14:39, 12 December 2022 (UTC)
 * Thx, A4; I have an app't this morning, so will respond later today, Bst, Sandy Georgia (Talk)  14:54, 12 December 2022 (UTC)
 * To use: Sandy Georgia  (Talk)  15:22, 12 December 2022 (UTC)

1. Scintigraphy


 * Tousi (2017): Reduced uptake on metaiodobenzylguanidine myocardial scintigraphy correlates with reduced postganglionic sympathetic cardiac innervation in Lewy body diseases, which can increase specificity for discriminating probable DLB from probable AD in milder cases of dementia. However, the latter is more commonly used in Japan and is not used in the USA. The evidence supporting the benefit of other therapeutic modalities is limited in DLB due to lack of extensive studies.
 * Although there is no direct biomarker of DLB, there are three indicative biomarkers: reduced dopamine transporter uptake in the basal ganglia as demonstrated by SPECT or PET, polysomnographic confirmation of REM sleep without atonia, and low uptake iodine-MIBG myocardial scintigraphy which has gained more recognition in Japan and East Asia [6] but is not used clinically in the USA.
 * 6. Manabe Y, Inui Y, Toyama H, Kosaka K. 123I-Metaiodobenzylguanidine myocardial scintigraphy with Curr Treat Options Neurol (2017) 19:42 Page 17 of 19 42 early images alone is useful for the differential diagnosis of dementia with Lewy bodies. Psychiatry Res. 2017;261:75–9.
 * Kosaka 2017, Yamada M, Chapter 12, p. 162. Article in a very large book: sources the 2001, nothing about which countries.
 * Bousiges O, Blanc F (June 2022) MIBG myocardial scintigraphy is an imaging technique for estimating sympathetic nerve damage, which post-mortem studies show as reduced in DLB. These damages are seen in primary heart disease, diabetic neuropathy, and also PD and DLB [42]. For DLB at the stage of dementia, the sensitivity ranges from 68.9% [53] N = 61 DLB (ratio method) to 100% N = 19 DLB (ratio method) [42]. The specificity of MIBG scintigraphy when compared to healthy controls or AD is usually excellent: 87% [53], to 92% [42] N = 19 DLB, ratio method [42,53]. Although MIBG scintigraphy seems to be informative, there is a lack of phase 3 studies to validate this biomarker in its use as a differential diagnostic tool between DLB and AD [54].

The reference to East Asia comes from Tousi (2017), but after scouring new and old sources, I can find no further information specifying which countries. Bousiges & Blanc explain why it's not used elsewhere, so that might be useful info to include. Personal opinion: I suspect it just hasn't taken hold in the rest of the world because it's mostly useful as possible discriminator between DLB and AD (an area still not well defined vis-a-vis biomarkers), and there are other ways of doing that-- that is, a lack of interest or funding in re-inventing the wheel with a new methodology in the Western world. Sandy Georgia (Talk)  18:34, 12 December 2022 (UTC)

2. Commercial biomarker tests


 * Armstrong (2017): In the United States, CSF testing for evidence of a synucleinopathy is available through a Food and Drug Administration 'breakthrough device designation', but this test is not currently covered by insurance providers and its role in routine clinical diagnosis is not yet established. ... commercial testing for synucleinopathies using skin punch biopsies is now available in the United States. As with CSF α-synuclein testing, the role that skin biopsy plays in routine clinical diagnosis of DLB is yet to be established.
 * Han (2022) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148991/ gives an update on the limitations (nothing new). Similar at
 * Santos (2022) However, CSF analysis procedures and advanced imaging modalities are either invasive or high-priced, and routinely unavailable.
 * Blanc, Bousiges (2022), : CSF Alpha-synuclein assay in the CSF has also an interest in the discrimination between DLB and AD but not in segregation between DLB and healthy elderly subjects. CSF synuclein RT-QuIC seems to be an excellent biomarker but its application in clinical routine remains to be demonstrated, given the non-automation of the process.

Similarly, I've re-examined the sources and done a new search, and have come up with little new information except that they aren't currently approved by insurance. Multiple potential biomarkers are under study by different groups, and all of them require very expensive research with the jury still out on all. (FDA approval has somewhat lost relevance following on recent scandals of product approval of dubious validity prompted by patient advocates (Aducanumab), resulting in the resignation of leading researchers from the FDA advisory panel which unanimously rejected the product.)  We can talk about what to add to improve clarity based on the new sources above, but we don't have a lot to work with. Sandy Georgia (Talk)  19:03, 12 December 2022 (UTC)

3. FDA 'breakthrough device' authorization I don't know when or what device was approved (or how many consumers are falling for those tests), but I suspect the approval you found was a different one than the one mentioned in the cited review. Sandy Georgia (Talk)  19:05, 12 December 2022 (UTC)

On the big picture, I hope the article is not leaving the impression that distinction between AD and DLB has reached a state where biomarkers can be easily or commercially applied: we aren't there yet, and most are still research protocols, expensive, and require considerable judgment. Unsure how to make sure the article is not leaving faulty impressions on this, but regardless of cost or FDA approval, you can't just get a test to help distinguish whether dementia is AD or DLB (which is what all of them are aiming to do). That pathologies frequently co-exist (DLB and AD) is a confounding factor in the whole matter of biomarkers. Sandy Georgia (Talk)  20:15, 12 December 2022 (UTC)


 * Thanks for taking the time to conduct this thorough research. It's quite interesting. And unfortunate. Although we cannot say more than RS do. I only added "however" to insist a bit more and avoid leaving readers with faulty impressions. Feel free to revert if you think it's not relevant. a455bcd9 (Antoine) (talk) 21:21, 12 December 2022 (UTC)
 * I did a bit more to work in the three new sources, without howevering; pls let me know if this is more clear ? Sandy Georgia (Talk)  22:42, 12 December 2022 (UTC)
 * Perfect: thanks! a455bcd9 (Antoine) (talk) 09:16, 13 December 2022 (UTC)