Talk:Dementia with Lewy bodies

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Random comments[edit]

Saw Sandy's call at WT:MED... Sorry no time for a detailed review, but can offer a few quick comments:

  • (Lead) The exact cause is unknown,[3] but involves deposits of Lewy bodies and Lewy neurites—abnormal clumps of alpha-synuclein protein—in neurons. and (Pathophysiology) DLB is characterized by the development of abnormal collections of alpha-synuclein protein within neurons, known as Lewy bodies and Lewy neurites. – These aren't quite right, as Lewy neurites are neurites (protrusions emanating from neurons) containing clumps of α-synuclein, not the clumps themselves.
    • To fix this, I decided not to try to define Lewy neurites in the lead: [1]. SandyGeorgia (Talk) 15:28, 2 May 2018 (UTC)
  • (Causes) Schematic of apolipoprotein E, whose gene increases the risk of DLB – This doesn't make sense. Suggest "Ribbon diagram of apolipoprotein E. A form of this protein is associated with increased risk of developing DLB." or similar.
    • Thank you Adrian J. Hunter, for all of this. Starting in now. I did not write that text, and have made your suggested change.[2] SandyGeorgia (Talk) 14:05, 2 May 2018 (UTC)
  • (Causes) but there are probably many factors involving both genetics and environmental influences. --> genetic (no s), as this is short for "genetic influences and environmental influences". Also probably "involving" --> "including".
  • (Causes) genetic, environmental and other disease processes – Any disease process that's not genetic is environmental by definition. There are no other possibilities.
  • (Causes) Typically the disease is not seen clustered in families, although having another family member with DLB is a risk factor, suggesting that DLB does not result from simple genetic alterations. – This doesn't make logical sense. Do you mean "Having another family member with DLB is a risk factor, although typically the disease is not seen clustered in families, suggesting that DLB does not result from simple genetic alterations"?
    • I have commented that sentence out for now, pending further digging. I suspect that I dropped a source there when I was reworking to remove the NINDS Lewy body dementia source. I will have to re-discover which source I was paraphrasing. SandyGeorgia (Talk) 22:48, 2 May 2018 (UTC)
  • (Causes) other risk factors include ... having an unhealthy lifestyle, which is known to contribute to dementia.
    • I find "unhealthy lifestyle" so vague as to be unhelpful.
    • The cited source says "some studies suggest that a healthy lifestyle— including regular exercise, mental stimulation, and a healthy diet— might reduce the chance of developing age-associated dementias" (emphases added), so this particular source doesn't support "is known to contribute".
      • Deleted entirely because only mentioned at NINDS, and as you point out, too vague to be helpful. SandyGeorgia (Talk) 22:38, 2 May 2018 (UTC)
  • (Soc & culture) McKeith and Dennis Dickson, a spokesperson for the Lewy Body Dementia Association, commented that Williams' symptoms and autopsy findings were explained by DLB. – Even with the wikilink, I don't like the way McKeith is named without any explanation of who he is (he's not mentioned earlier in the article). Suggest either:
    • Include a brief explanation of McKeith's importance, as for Dickson, or
    • Since this doesn't seem to be contentious, just drop the attribution and state that Williams' symptoms and autopsy findings were explained by DLB.
  • (Soc & culture) His widow said Robin Williams (shown in 2011) was diagnosed during autopsy as having diffuse Lewy bodies. – Do we need the explicit attribution here? Unless there's some reason to doubt his widow, surely "Robin Williams (shown in 2011) was diagnosed during autopsy as having diffuse Lewy bodies." is fine, and reads better.
    • I dropped important text when I summarized this from the main article-- it is confusing enough that I think we might keep attribution. The problem is that neither the autopsy report nor Robin Williams' widow used the terms correctly, so we need to attribute what they actually said, and then add an explanation from McKeith and the LBDA. I readded all of this from the main article. Is that better? SandyGeorgia (Talk) 16:09, 2 May 2018 (UTC)
  • (Research directions) As of 2018 there were no well-validated neuroimaging modalities to measure alpha-synuclein in the brains of living people, but this was an active area of research. Shouldn't this be "is an active area of research"? Even if the cited year was 2017 (simulating myself reading this in the future), is still sounds right to me. "As of..." sounds like present tense.

Adrian J. Hunter(talkcontribs) 13:19, 2 May 2018 (UTC)

Thanks so much for all of this, Adrian; I did some, but will have to do the rest when I am home, and will ping you when finished. SandyGeorgia (Talk) 16:21, 2 May 2018 (UTC)
@Adrian J. Hunter: thank you so much for all of that. All of the changes discussed above are in this diff. I believe the Causes section would be much stronger if I could work in more of Weil2017, but I don't feel comfortable attempting to paraphrase that material myself.
If you have time to review what I added in on the nomenclature problem vis-a-vis Robin Williams' wife's statement, another opinion would be helpful. I am concerned that we just don't have a clear enough case to outright say he had DLB, when the autopsy used a confusing term, which others had to explain.
Thank you again for helping! SandyGeorgia (Talk) 22:55, 2 May 2018 (UTC)
Thanks Sandy, and sorry for my slow response. These are great fixes, especially this one which you asked me about above.
What exactly is the nomenclature problem? Based on the LBDA statement, the autopsy used "diffuse Lewy body dementia", which is a rarer (though not incorrect?) alternative to "diffuse Lewy body disease". The clarification is that "diffuse Lewy body dementia" is based on molecular pathology, and does not imply actual dementia, as some reporters had evidently inferred. Looking at the widow's own words in the Neurology article, she says William's had diffuse Lewy body disease, consistent with the autopsy (based on LBDA). So I'm not seeing any need in our article to separately report on what the widow said and what the autopsy said. So is the issue whether diffuse Lewy body disease is the same thing as dementia with Lewy bodies? Adrian J. Hunter(talkcontribs) 13:56, 9 May 2018 (UTC)
There are two problems. 1) Misperceptions about whether he had dementia. 2) The autopsy said Lewy body dementia, not dementia with Lewy bodies. But Lewy body dementia is an umbrella term for Parkinson's disease dementia and dementia with Lewy bodies. So, since he had Parkinson's, one can misinterpret that his Lewy body dementia was Parkinson's disease dementia rather rather than dementia with Lewy bodies. We can guess the autopsy meant to say diffuse Lewy body disease rather than diffuse Lewy body dementia, but we don't really know. SandyGeorgia (Talk) 17:33, 9 May 2018 (UTC)

Further comments from Seppi[edit]

I'm glad to see the issues I previously mentioned have been resolved. The only thing I see which doesn't seem to be consistent with the MOS pertains to the use of bold text and MOS:BOLD/MOS:NOBOLD. Text like "other supportive features" shouldn't appear in boldface per MOS:NOBOLD; the only exception I can think of off the top of my head as to when doing this is appropriate is when the term is bolded in a section which is the target of a redirect for that term (e.g., see reward cross-sensitization and conditioned reinforcer). This practice follows from MOS:WORDSASWORDS: "If, however, a term is strictly synonymous with the subject of the article (i.e. the likely target of a redirect), then boldface should be used in place of italics or quotation marks at such a first occurrence.".

Bold text that delineates sub-topical coverage, such as "Impaired attention, executive function, and visuospatial function", REM sleep behavior disorder, Parkinsonism, and Visual hallucinations in the Dementia with Lewy bodies#Core features section, should really be changed to normal text and placed under a sub-heading of the same name if topical delineation is desired (an alternative solution is also fine with me though). Again though, if these terms are the targets of redirects to the corresponding section in which they're located, they should remain bolded in that section (per the above quote from MOS:WORDSASWORDS).

FWIW, I don't think it's correct to use a bold wikilink like "executive function, and visuospatial function"; John pointed that out to me when it was applied to the lead text in amphetamine a while back (i.e., alpha-methylphenethylamine; compare to the currect version: alpha-methylphenethylamine). Seppi333 (Insert ) 21:40, 30 May 2018 (UTC)