Talk:Dementia with Lewy bodies

Wording

This "a wide range of symptoms affecting behavior, cognition, movement, sleep and the autonomic nervous system."

Does not make much sense. The symptoms do not just affect behavior, movement and sleep but the symptom are changes to behavior, movement and sleep. Adjusted a bit.

Doc James (talk · contribs · email) 03:45, 19 March 2020 (UTC)

Review

I'll post here as I read through. My first thoughts are if we can push Classification down the page. Most of the words in that section are about a foot long and unavoidable terminology. I fear readers may be put off thinking "if this is how it is going to be...". -- Colin°^Talk 17:23, 7 April 2020 (UTC)

Thanks, Colin; I will wait 'til you are completely finished with your review, before I start responding, correcting, etc. Please let me know when I should weigh in, so as not to edit conflict. SandyGeorgia (Talk) 17:31, 7 April 2020 (UTC)

Ok. I think you can be fairly sure I won't comment in my sleep. -- Colin°^Talk 17:38, 7 April 2020 (UTC)

OK, I will take a few hours to tidy my garden, on this nice spring day, and check in later. SandyGeorgia (Talk) 18:00, 7 April 2020 (UTC)

"can damage different regions of the nervous system, including multiple brain regions in the central nervous system, and the autonomic nervous system" There's a fair bit of repetition (different regions / multiple brain regions) and overlap (nervous system, central nervous system and autonomic nervous system). What is the point we are trying to make? It seems that other dementias only attack localised areas or specific areas of the brain, whereas this is more widespread. -- Colin°^Talk 17:38, 7 April 2020 (UTC)

"affect several domains of functioning" seems neurology jargon. Can we put "domains of functioning" into layman's terms? -- Colin°^Talk 17:38, 7 April 2020 (UTC)

"An identifiable prodromal phase occurs in DLB" Most readers won't know prodomal so start off not following this. If we chop that out and begin with "In the early phase of the disease, signs ..." and conclude "DLB is distinguishable from AD even in this prodromal phase. (my bold) That then informs the reader that "prodromal phase" and "the early phase" are the same thing, and they learn a new word (yay for free educational content). Alternatively, since we don't use that word again, it is up to you if you think it worth teaching here. We could just wikilink "the early phase". -- Colin°^Talk 17:38, 7 April 2020 (UTC)

Colin. Yikes, it's rougher going in here than I realized. OK, I can't find a way to move Classification down, because we need all those terms. I tried to simplify. Tried to rejig the repetition about the nervous system. Reworked the domains of functioning. Move the "distinction from AD" to the differential diagnosis section and re-jigged all of that. Here are my changes so far, but you may want to start over at Classification and see if it's flowing better. I didn't exactly make all the changes you suggested, and this may need another round. Because, yea, it shouldn't be this tough at the top of the article. I will dig in to the "essential, core, etc" tomorrow; I want to get back into the sources to make sure I get that done with precision. SandyGeorgia (Talk) 01:46, 8 April 2020 (UTC)

Another stab at this here. SandyGeorgia (Talk) 18:23, 9 April 2020 (UTC)

By the way, Colin, the naming in this condition is absurd, which adds to the difficulty in writing about it. That the Lewy body dementias include dementia with Lewy bodies and Parkinson's disease dementia, which also has to be distinguished from Parkinson's disease, while DLB often co-occurs with Alzheimer's all make for a ridiculous slog in writing. SandyGeorgia (Talk) 18:52, 9 April 2020 (UTC)

"essential, core, and supportive features" I think we need to say why they are divided so. I'm thinking about the complex diagnostic criteria at tuberous sclerosis with major and minor features. Is this an all patients / most patients / some patients grouping, or is there another way of wording that. -- Colin°^Talk 17:43, 7 April 2020 (UTC)

Added a sentence. [1] Next! SandyGeorgia (Talk) 18:23, 9 April 2020 (UTC)

"Individuals with visual hallucinations and one of the Lewy body dementias generally have more severe cognitive impairment". My first thought was more severe than what? It kinda reads like more severe than people with VH due to some completely other cause. I checked the source an the relevant bit seems to be "VHs seem to be more severe and complex in LBD patients with cognitive impairment, which often present with lack of insight about the unreal nature of their experience". I don't think we need the "one of the Lewy body dementias" since this article is just about DLB. Also, our only comment about insight is that it is "in some cases", we don't mention that it is "often lacking". I'm not sure whether hallucinations (due to any cause) are often perceived as unreal or real, so I think the reader needs a base. Does cognitive impairment correlate with less common insight and more severe and complex VH. -- Colin°^Talk 21:21, 8 April 2020 (UTC) I just read the next sentence. Ok, I think the sentence I quote is an inferior duplicate and I'll remove it. -- Colin°^Talk 21:25, 8 April 2020 (UTC)

"[d]egeneration". Is this just a case where you used a lower-case d rather than the original upper-case D? If so, I think our general readership need not be troubled by such high academic standards of quoting. Maybe there is a MOS guideline, but it seems to just make it harder to read. And I dread to think what a screen reader makes of it. -- Colin°^Talk 08:51, 10 April 2020 (UTC)

Rejigged the sentence to fix, [2] SandyGeorgia (Talk) 09:11, 10 April 2020 (UTC)

"have GBA and SNCA mutations" Why are GBA and PARK11 italicised earlier but not here? Would it be more understandable written as "have mutations in the GBA and SNCA genes". I wonder if this "has XYZ mutations" is a geneticists shorthand. -- Colin°^Talk 09:07, 10 April 2020 (UTC)

Done, [3]. @Adrian J. Hunter: might I interest you in reviewing the Causes section here? SandyGeorgia (Talk) 09:26, 10 April 2020 (UTC)

Sure. I'll take a closer look tomorrow when I'm fresh, but for now I'll suggest this re-wording in the final paragraph: "Risk factors for developing DLB include having an affected family member, being aged over 50, and having REM sleep behavior disorder (RBD).[7] Additional risk factors for rapid conversion of RBD to a synucleinopathy are impairments in color vision or the ability to smell, mild cognitive impairment, and abnormal dopamingeric imaging.[26]" It's easier to parse this way. Adrian J. Hunter^{(talk•contribs)} 11:12, 10 April 2020 (UTC)

Thanks, Adrian; I did this, but am not sure if I got everything you intended-- it looks like you kept the second sentence as is? SandyGeorgia (Talk) 15:08, 10 April 2020 (UTC)

"a poorer survival rate than in AD". Tough one this. But I think "rate" is the wrong word. -- Colin°^Talk 20:31, 10 April 2020 (UTC)

Reworked, here. SandyGeorgia (Talk) 21:13, 10 April 2020 (UTC)

Ok. I've reached the end (excluding lead). It is a difficult subject but my impression is a fully comprehensive treatment of the subject, and prose that has a flow and structure that is missing from so many WP articles. -- Colin°^Talk 20:47, 10 April 2020 (UTC)

Thanks for everything, Colin. I will sit on it for a few days, and then give it a full going over again to see if I can lessen the terminology and other issues which make this such a tough read. Stupid nomenclature, lots of long complex terms, and a very complex condition, too! Best, SandyGeorgia (Talk) 21:13, 10 April 2020 (UTC)

Copyedit

@Outriggr: would you like to have a go at the body of this article, now that Colin has finished? (I am pretty sure Ceoil has already combed through it, and Yo-man has left the building.) Once you are satisfied with the body, I will turn my attention to trying to make the lead more friendly, as there are just too many confusing terms and too much difficult nomenclature in this topic, so for now, let's not try to address the lead. With more clarity coming to the body of the article, it becomes easier to see how to address the lead. SandyGeorgia (Talk) 23:00, 11 April 2020 (UTC)

Outriggr, that was one of your finest copyedits ever; thank you so much. Ceoil, if you are content with the status of the body of the article, I will next outline the things I see that need improvement in the lead-- but I want to be sure the body is set before I tackle that. Specifically, is the terminology in the body of the article still too dense (because it sure is in the lead)? SandyGeorgia (Talk) 12:52, 13 April 2020 (UTC)

Thank you. I'm not done yet; perhaps editing the very last section (an easy one) gave that impression. I'm sorry Sandy but I'm very slow. One or two (sub)sections per day is all I have in me. Outriggr (talk) 04:43, 14 April 2020 (UTC)

ah ha! I did think you were done and even abused of your kindness and invited you to ce another medical article. Reminder to self to revisit

• https://en.wikipedia.org/w/index.php?title=Dementia_with_Lewy_bodies&diff=next&oldid=950850481

• Is this better? [4] SandyGeorgia (Talk) 15:31, 14 April 2020 (UTC)

• https://en.wikipedia.org/w/index.php?title=Dementia_with_Lewy_bodies&diff=next&oldid=950853322

• Lysomal is a thing, but so is lysosomal.[5] The source says "lysomal", but I don't know if the terms are interchangeable. Also, the whole thing is a direct quote that I don't know how to paraphrase. LeadSongDog might you have a look at Causes (and the rest of the article, if I can entice you)? SandyGeorgia (Talk) 15:32, 14 April 2020 (UTC)

• I suppose they're both valid and mean the same thing. Incidentally I forgot it was a quote at the moment I made the 'correction'. In my mind, I simply queried it.
• Here's a journal article whose HTML title as displayed by Springer fails to transcribe "lysosomal" properly from the PDF title of the actual, original article below it!: [6] I can't generalize from that to "always a typo", but I couldn't help but wonder if this was a common jargony typo due to the similarity of the dropped syllable to the next syllable. Anyway, it's in a quote and [sic] is not obviously warranted. Outriggr (talk) 05:36, 15 April 2020 (UTC)

• https://en.wikipedia.org/w/index.php?title=Dementia_with_Lewy_bodies&diff=prev&oldid=950855184

• Open to suggestions from all of you, but the issue here is that we are talking about how the various terms are used, in other words MOS:WORDSASWORDS. So, I preferred italics. What do you all think? There will be a quiz pre-FAC, in which each one of you must answer, "What condition did Robin Williams have?" Let's see if that is coming across here. SandyGeorgia (Talk) 15:36, 14 April 2020 (UTC)

• I put the italics back. I don't care one way or the other. But I don't think it's as clear-cut a case as the WORDSASWORDS examples because we are still quite interested in the semantic content of what was in the quotes. I don't think the article would be telling us what various parties called the underlying disorder if we weren't interested in the semantic issues with terminology, so to quote an autopsy report or someone's perception of an autopsy report with... quotes instead of italics makes sense to me. And then, why not add more italics, to the first sentence: "His widow said that his autopsy found diffuse Lewy body disease". The lack of italics there confirms that the writer wants to emphasize the semantic issues at stake, not just terms. Anyway, splitting hairs. Outriggr (talk) 05:36, 15 April 2020 (UTC) There's also "Frederic Lewy (1885–1950) was the first to discover the abnormal protein deposits (later called "Lewy body inclusions")" in #History. Should those quotes be italics? Probably... Outriggr (talk) 05:40, 15 April 2020 (UTC)

• I leave this to your better judgment: I am more concerned with whether Wikipedia’s voice is giving the impression if we, or anyone, know what Robin Williams had. What say ye? SandyGeorgia (Talk) 08:31, 15 April 2020 (UTC)

in am when I am really awake. SandyGeorgia (Talk) 08:33, 14 April 2020 (UTC)

Outriggr, I replied to several above, pinged LeadSongDog for help on one, and request feedback from Ceoil and Colin on WORDSASWORDS on Robin Williams. Bst, SandyGeorgia (Talk) 15:37, 14 April 2020 (UTC)

I read the paragraph again. Obviously, if we had lots of famous people diagnosed, then a whole paragraph on "what does the autopsy say" would be overkill. I'd still be tempted to try to condense. Are we reflecting the literature generally or giving too much emphasis on one person's speculation is the key question. I generally think Wiki should avoid arguing-the-case in front of the reader, but sometimes we have to explain there is no consensus and here are the arguments. It is always going to be awkward and confusing that "Lewy body dementia" and "Dementia with Lewy bodies" aren't the same thing. Sometimes things are easier when it is just an abstract name like "Georgia's syndrome" and all we have to worry about is an 's, which, you know, never causes any problems on wiki. Ever. -- Colin°^Talk 08:58, 17 April 2020 (UTC)

Trimmed some, [7] SandyGeorgia (Talk) 11:19, 18 April 2020 (UTC)

 Not done SandyGeorgia, I apologize but I don't think I will be able to continue copy editing this article. My discomfort is increasing and concentration is difficult. Outriggr (talk) 03:19, 17 April 2020 (UTC)

Outriggr, sorry to hear that. Take care. -- Colin°^Talk 08:58, 17 April 2020 (UTC)

Missing the Riggr family, and hope they are better soon.  :( SandyGeorgia (Talk) 11:20, 18 April 2020 (UTC)

To but in, really excellent work Sandy, Colin and Outriggr. Having been following sentence by sentence, very impressed by evident ability and collab approach. This is wiki at its best, a pooling of different talents. Ceoil (talk) 13:53, 18 April 2020 (UTC)

New review

I worked in a new review-- no significant changes to text, but was able to upgrade some of the older citations.[8] SandyGeorgia (Talk) 16:27, 18 April 2020 (UTC)

Lead rewrite

@Ceoil, Colin, Outriggr, and Yomangani: The nomenclature and the number of complicated terms in this topic make for rough going. We have:

Lewy body dementia vs. Dementia with Lewy bodies; and

Parkinson's disease dementia as a Lewy body dementia, distinct from Parkinson's disease; and

Words and terms that are offputting to lay readers, like synucleinopathies, Acetylcholinesterase inhibitors, and ¹²³iodine-metaiodobenzylguanidine (¹²³I-MIBG) myocardial scintigraphy;

along with the complexity of the disease, that affects not only the brain, but the heart, gastointestinal tract, the whole autonomic nervous system-- more big words. In other words, it affects the brain and the body. And that, often, a precise statement is given for Lewy body dementias rather than dementia with Lewy bodies, for example, in epidemiology.

I suggest that some differences in the lead here (relative to, for example, Tourette syndrome) are going to be useful in making the lead more digestible for layreaders. Specifically, I am thinking of including less specifics in the lead than is typical, to avoid overburdening the reader with big words. Some precision will be sacrificed, but the lead may be more digestible to the average reader. I'd appreciate feedback on ideas like the following, now that you are all familiar with the topic:

1. Acetylcholinesterase inhibitors, such as --> Medicines such as ...
2. ... widespread deposits of abnormal clumps of alpha-synuclein protein—known as Lewy bodies and Lewy neurites—that form in neurons of the diseased brain
3. The abnormal deposits of protein that are the underlying mechanism of the disease were discovered in ... need to get rid of "underlying mechanism" somehow ... cause is not right ... lead to ?
4. Together with Parkinson's disease dementia, it is one of two dementias classified as the Lewy body dementias ... needs to be moved up in the first para, to get that confusion out of the way straight on. Because, most readers go to the wrong article.
5. Life expectancy following diagnosis is about eight years ... switch to lay language ... people with DLB live about eight years after diagnosis.
6. and diffuse Lewy body disease was first described by Kenji Kosaka in 1976 ... is confusing because it introduces yet another term ... first described the condition ... (even though he named it differently)
7. Antipsychotics are usually avoided, even for hallucinations, because people with DLB are sensitive to them,[a] and their use can result in death. ... not really needed, they can die is good enough.
8. A multidisciplinary approach is taken to management of the different symptoms; have to do better on that. A team of different kinds of specialists ??? Something to avoid All These Big Words.
9. There is no cure, or medication to modify its progression. More medical lingo ... or medication that can stop the disease from progressing ?
10. DLB is not usually inherited, but there is a genetic association in a small number of families. Medical lingo ... DLB is not usually inherited except perhaps in a small number of families.
11. A probable diagnosis is made based on symptoms and biomarkers which may include blood tests, neuropsychological tests, medical imaging, and polysomnography. There are Many problems here, trying to do too much, and too many big words. The probable is there because of the difference between probable and possible (switch to "likely" to avoid the criteria difference between the two?), and no real diagnosis except on autopsy. Sugggest changing to something like: Definitive diagnosis can only be made upon autopsy, but a likely diagnosis can be made based on symptoms and several kinds of medical tests.
12. The autonomic nervous system is usually affected, resulting in low blood pressure with standing, and changes in heart and gastrointestinal function, with constipation as one of the most common symptoms. Ugh. All of this needs to be rejigged to end up saying, "It affects more than memory or the brain", because MOST people think of dementia as memory-related, and don't realize the extent of symptoms in DLB. Need to find a way to say "body and brain" without all these big words.
13. The whole first paragraph is out of whack. RBD is a core symptom ... but so are all of these ... Other frequent symptoms include visual hallucinations; marked fluctuations in attention or alertness; and slowness of movement, trouble walking, or rigidity. And, yet, you can be diagnosed with only dementia plus one core symptom, or even dementia with one biomarker (no core symptom). That is ...

    Possible DLB can be diagnosed when dementia and only one core feature are present or, if no core features are present, at least one indicative biomarker presents AND

    You can be diagnosed with possible DLB without having ANY of the things listed in the lead except dementia and one of the indicative biomarkers.

    This has to be fixed somehow, because we don't want readers, who don't go beyond the lead, to think one must have all or even most of what is mentioned in the lead to have DLB. Further, most of parkinsonism symptoms aren't usually present-- only one is more typical.

So, there are a ton of issues to work through here, which is why I have put the lead off 'til last. Would like to hear ideas before I start trying to rewrite, because this will be a slog. SandyGeorgia (Talk) 19:01, 13 April 2020 (UTC)

Proposal

Current

Proposed re-write

Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in behavior, cognition, movement, sleep, and the autonomic nervous system. It is progressive and usually diagnosed when cognitive decline interferes with normal daily functioning. A core feature is REM sleep behavior disorder (RBD), in which people lose normal muscle paralysis during REM sleep and act out their dreams. Memory loss is not always an early symptom; RBD may appear years or decades before other symptoms. Other frequent symptoms include visual hallucinations; marked fluctuations in attention or alertness; and slowness of movement, trouble walking, or rigidity. The autonomic nervous system is usually affected, resulting in low blood pressure with standing, and changes in heart and gastrointestinal function, with constipation as one of the most common symptoms. Mood changes such as depression and lack of interest are common. The exact cause is unknown, but involves widespread deposits of abnormal clumps of alpha-synuclein protein—known as Lewy bodies and Lewy neurites—that form in neurons of the diseased brain. DLB is not usually inherited, but there is a genetic association in a small number of families. A probable diagnosis is made based on symptoms and biomarkers which may include blood tests, neuropsychological tests, medical imaging, and polysomnography. Other conditions that share some symptoms of DLB include Alzheimer's disease (AD), Parkinson's disease, delirium, and rarely, psychosis. There is no cure, or medication to modify its progression. Treatments aim to relieve some of the symptoms and reduce the burden on caregivers. Acetylcholinesterase inhibitors, such as donepezil and rivastigmine, are effective at improving cognition and overall functioning, and melatonin can be used for sleep-related symptoms. Antipsychotics are usually avoided, even for hallucinations, because people with DLB are sensitive to them, and their use can result in death. A multidisciplinary approach is taken to management of the different symptoms; treating one symptom in isolation might worsen other symptoms. DLB is one of the three most common types of dementia, along with Alzheimer's, and vascular dementia. Together with Parkinson's disease dementia, it is one of two dementias classified as the Lewy body dementias. It typically begins after the age of 50, and about 0.4% of people over 65 are affected. People in the latter stages of DLB may be unable to care for themselves. Life expectancy following diagnosis is about eight years. The abnormal deposits of protein that are the underlying mechanism of the disease were discovered in 1912 by Frederic Lewy, and diffuse Lewy body disease was first described by Kenji Kosaka in 1976.

Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in sleep, behavior, cognition, movement, and automatic bodily functions. Memory loss is not always an early symptom. The disease worsens over time and is usually diagnosed when cognitive decline interferes with normal daily functioning. Together with Parkinson's disease dementia, it is one of the two Lewy body dementias. It is a common form of dementia, but the number of people affected is not known accurately and many diagnoses are missed. The disease was first described by Kenji Kosaka in 1976. REM sleep behavior disorder (RBD)—in which people lose the muscle paralysis that normally occurs during REM sleep and act out their dreams—is a core feature. RBD may appear years or decades before other symptoms. Other core features are visual hallucinations; marked fluctuations in attention or alertness; and parkinsonism (slowness of movement, trouble walking, or rigidity). Not all features must be present for a diagnosis. Definitive diagnosis requires an autopsy, but a likely diagnosis is made based on symptoms and tests which may include blood tests, neuropsychological tests, imaging, and sleep studies. There is a genetic association in a small number of families, but DLB is not usually inherited. The exact cause is unknown, but involves widespread deposits of abnormal clumps of protein that form in neurons of the diseased brain. Known as Lewy bodies (discovered in 1912 by Frederic Lewy) and Lewy neurites, these clumps also affect the autonomic nervous system. Heart function and every level of gastrointestinal function—from chewing to defecation—can be affected, with constipation as one of the most common symptoms. Low blood pressure upon standing can also be a symptom. DLB also affects behavior; mood changes such as depression and lack of interest are common. DLB typically begins after the age of fifty and people with the disease live about eight years after diagnosis. There is no cure or medication to stop the disease from progressing, and people in the latter stages of DLB may be unable to care for themselves. Treatments aim to relieve some of the symptoms and reduce the burden on caregivers. Medicines such as donepezil and rivastigmine are effective at improving cognition and overall functioning, and melatonin can be used for sleep-related symptoms. Antipsychotics are usually avoided, even for hallucinations, because severe and life-threatening reactions occur in almost half of people with DLB, and their use can result in death. Management of the many different symptoms is challenging, as it involves multiple specialties and education of caregivers.

Discussion

Getting the flow right is a challenge. I can't find a way to work the last paragraph in that flows. SandyGeorgia (Talk) 02:21, 17 April 2020 (UTC)

I'd append those onto the first paragraph. Cas Liber (talk · contribs) 05:39, 17 April 2020 (UTC)

Agree with Cas about appending the history sentence to the end of the first. I read your rationale for the lead rewrite and it all seems very sensible. I haven't studied the before/after in detail yet. I'm going to be busy with That Other Thing for a while but will try to get back to this. -- Colin°^Talk 09:06, 17 April 2020 (UTC)

I tried to work it in where Lewy bodies are first mentioned, but then I got tangled up in whether Lewy himself actually mentioned neurites as well as bodies, and that turned in to a mess. Adding it to the first para was my next idea, but I was concerned that would pop everyone's circuit breakers. I will do that in draft above so we can continue.[9] SandyGeorgia (Talk) 13:27, 17 April 2020 (UTC)

oops, doesn't work. Lewy bodies are now mentioned before they are defined. SandyGeorgia (Talk) 13:28, 17 April 2020 (UTC)

Move para 3 to above para 2 - as you are explaining what it is higher up in the lead. Agree about the conundrum of mention of Lewy bodies....thinking about how to fix. Cas Liber (talk · contribs) 13:39, 17 April 2020 (UTC)

How about now? I rejigged to separate Mr. Lewy and the Bodies, which I think solved that problem, and made several other ces as well. I considered earlier moving the third para to the second, but that results in minor symptoms being mentioned before the core features, so seemed to give the wrong emphasis. Also, RBD is a big deal in DLB; the fact that polysomnography can pick up RBD decades before diagnosis-- and is highly predictive of a future synucleinopathy-- is huge. SandyGeorgia (Talk) 13:57, 17 April 2020 (UTC)

The lead should have references. Would you be willing to add those in? Doc James (talk · contribs · email) 19:55, 17 April 2020 (UTC)

Trying to rewrite the lead showed me exactly why I was unable to before. When you have to work around bits and pieces, with each clause having to be precisely cited, it constrains the ability to write clearly and put the narrative in a way that works best. So, when doing this, I freed myself from thinking about which number is attached to which piece. (That is, I tried to escape the confines of being a WikiWriter-- I had the same problem with life expectancy-- the need to get the links right also constrains our writing ability, because sometimes rephrasing around the need to link is complicated.) I reconstructed this more-or-less freehand, trying specifically not to worry about which citation gets attached to which piece. I also wrote it in a much broader level of generality (getting rid of some of the excess terminology and verbiage), so that as of now, almost all of it is entirely general and not screaming for citations (there is a bit of hard data that definitely requires citation).

Do you like the prose so far, and what do you think requires citation? SandyGeorgia (Talk) 20:01, 17 April 2020 (UTC)

Terms such as "autopsy" and "defecation" should be Wikilinked.

Otherwise no concern with the rearranging of the text.

We have lot of numerical and other details that would benefit from references.

References for claims around medication use also important as it allows our readers to easily determine when that statement was made. Doc James (talk · contribs · email) 20:03, 17 April 2020 (UTC)

I linked defecation, but suggest that autopsy is a common term, and we should avoid the sea of blue that WP:OVERLINKing causes. Not hung up on this, though, and will defer to others.

Happy that you are happy with the order of the narrative-- it really flows better IMO with the different pieces placed in different places.

Agree that medication text could be cited, along with "hard data" (numbers), since in this case, the medication issues are surprising and can be severe ... I'd like to put a free full text to them easily at hand for readers.

No hurry here overall, and waiting for more feedback, but I don't want to add little numbers until we have prose set, as they can be constraining to the writing. SandyGeorgia (Talk) 20:35, 17 April 2020 (UTC)

Happy with order now Cas Liber (talk · contribs) 00:20, 18 April 2020 (UTC)

I feel confident now that, if we can finalize these lead issues, we are FAC-ready. I would really love to be able to see the WPMED FA production trend upward. On the other hand ... at the rate things are going over there, it will sit at FAC for two or three months, by which time (at my age), I could be dead from COVID :/ :/ SandyGeorgia (Talk) 00:33, 18 April 2020 (UTC)

Lead looks fine to me (stick refs for the numbers in or not - that is straightforward) and nominate. You could tinker about this indefinitely. Cas Liber (talk · contribs) 14:37, 18 April 2020 (UTC)

Grand! After breakfast (tortilla española) I will put this in sandbox to work on citations. I’ll be back with proposal. I would prefer, though, to have final Adrian J. Hunter look pre-FAC, and LeadSongDog hasn’t edited for days. SandyGeorgia (Talk) 14:52, 18 April 2020 (UTC)

Lead with citations

Dementia with Lewy bodies
Other names	Diffuse Lewy body disease
Microscopic image of Lewy bodies
Specialty	Neurology, psychiatry
Symptoms	Dementia, abnormal behavior during REM sleep, fluctuations in alertness, visual hallucinations, slowness of movement
Usual onset	After the age of 50, typically 76
Duration	Long term
Causes	Unknown
Diagnostic method	Based on symptoms and biomarkers
Differential diagnosis	Alzheimer's, Parkinson's disease dementia, certain mental illnesses, vascular dementia
Medication	Acetylcholinesterase inhibitors such as donepezil and rivastigmine; melatonin
Prognosis	Average survival 8 years from diagnosis
Frequency	About 0.4% of persons older than 65

Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in sleep, behavior, cognition, movement, and automatic bodily functions. Memory loss is not always an early symptom. The disease worsens over time and is usually diagnosed when cognitive decline interferes with normal daily functioning. Together with Parkinson's disease dementia, it is one of the two Lewy body dementias. It is a common form of dementia, but the number of people affected is not known accurately and many diagnoses are missed. The disease was first described by Kenji Kosaka in 1976.

REM sleep behavior disorder (RBD)—in which people lose the muscle paralysis that normally occurs during REM sleep and act out their dreams—is a core feature. RBD may appear years or decades before other symptoms. Other core features are visual hallucinations; marked fluctuations in attention or alertness; and parkinsonism (slowness of movement, trouble walking, or rigidity). Not all features must be present for a diagnosis. Definitive diagnosis requires an autopsy, but a likely diagnosis is made based on symptoms and tests which may include blood tests, neuropsychological tests, imaging, and sleep studies.

There is a genetic association in a small number of families, but DLB is not usually inherited. The exact cause is unknown, but involves widespread deposits of abnormal clumps of protein that form in neurons of the diseased brain. Known as Lewy bodies (discovered in 1912 by Frederic Lewy) and Lewy neurites, these clumps affect both the central nervous system and the autonomic nervous system. Heart function and every level of gastrointestinal function—from chewing to defecation—can be affected, with constipation as one of the most common symptoms. Low blood pressure upon standing can also be a symptom. DLB also affects behavior; mood changes such as depression and lack of interest are common.

DLB typically begins after the age of fifty and people with the disease live about eight years after diagnosis. There is no cure or medication to stop the disease from progressing, and people in the latter stages of DLB may be unable to care for themselves. Treatments aim to relieve some of the symptoms and reduce the burden on caregivers. Medicines such as donepezil and rivastigmine are effective at improving cognition and overall functioning, and melatonin can be used for sleep-related symptoms. Antipsychotics are usually avoided, even for hallucinations, because severe and life-threatening reactions occur in almost half of people with DLB, and their use can result in death. Management of the many different symptoms is challenging, as it involves multiple specialties and education of caregivers.

Citations
References

Discussion 2

Here's what I've done.

• I have varied the sources used so that between the infobox and the lead, we have 11 full-text sources, accessible to our readers; these include nine journal citations, one NIH and one NINDS, for variety and different reading levels.
• I have cited the dates, statistics, data, and medication text.
• Because of some of the ways I combined thoughts, some sentences require multiple citations now, which would gum up the lead. In order to NOT deface the lead with lots of little numbers-- that are not required by WP:LEADCITE-- but to provide the citations for translators who may need them, I have added inline comments to the rest of the citations. James, if you look in edit mode, you should find everything cited, even though at times, multiple citations are required where thoughts are combined. SandyGeorgia (Talk) 17:39, 18 April 2020 (UTC)

An astute IP edit

Thank goodness for astute IPs;[10] but there is no way to thank them! I am not going to go back and check, but I imagine I had an autofill issue there. SandyGeorgia (Talk) 22:23, 15 April 2020 (UTC)