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For Kathrynne and others who may be interested in DLBD: Here are 4 references from my CSR files, which are also in the Parkinsn list Archives: You can get abstracts from Medline, but if this is sufficient, it's probably easier to locate. (Sorry to be late with this- my ISP is going nuts and I couldn't log on.) Hely M et al; J Neur Neurosurg Psy 1996;60:531-538: Diffuse Lewy body disease (DLBD) looks like PD at first but also includes dementia, either at onset or later in progression. Albin R et al; Neur 1996;47:462-466: Six demented patients were studied by FD-PET, which can show local distribution of dopamine metabolism, and CAT scan. Five of the six showed some clinical signs of PD, and two who responded to levodopa were so diagnosed. On autopsy later, all six were found to have Diffuse Lewy Body Disease, a condition much more pervasive and disabling than PD. Five of the six reported visual hallucinations, and the two diagnosed with PD while living were distinct in having "cognitive fluctuations". Despite past impression, apparently FD-PET failed to distinguish DLBD from PD. Louis E et al;Neur 1997;48:376-380: While Lewy bodies are always present in PD, some consider PD to be a distinct member of a family of Lewy-body diseases. Authors believe, for example, that up to 88% of diffuse Lewy-body disease (DLBD) cases are misdiagnosed as PD. To test the hypothesis, they analyzed clinical signs of 31 pathologically (postmortem) verified DLBD cases and 34 similarly studied PD cases. There were no differences in rigidity, bradykinesia, dystonia, or gaze palsy, but DLBD cases had older onset, more common myoclonus, less common rest tremor, and less common response to or perceived need for levodopa. Any one of the last 4 signs is 10 times more likely to indicate DLBD. Litvan I et al; Arch Neur 1998;55:969-978: Presence of Lewy bodies is no longer considered essential to diagnosis of PD, and there is some question as to whether PD and dementia with Lewy bodies are two distinct diseases or not. The authors had 6 neurologists review clinical records of a diverse cohort, and compared their opinions with autopsy findings. -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013