For probable major or mild neurocognitive disorder with Lewy bodies, the indi- vidual has two core features, or one suggestive feature with one or more core features.
For possible major or mild neurocognitive disorder with Lewy bodies, the individ- ual has only one core feature, or one or more suggestive features.
1. Core diagnostic features: a. Fluctuating cognition with pronounced variations in attention and alertness.
b. Recurrent visual hallucinations that are well formed and detailed.
c. Spontaneous features of parkinsonism, with onset subsequent to the develop- ment of cognitive decline.
2. Suggestive diagnostic features: a. Meets criteria for rapid eye movement sleep behavior disorder.
b. Severe neuroleptic sensitivity.
D. The disturbance is not better explained by cerebrovascular disease, another neurode- generative disease, the effects of a substance, or another mental, neurological. or sys- temic disorder.
Coding note: For probable major neurocognitive disorder with Lewy bodies, with behav- ioral disturbance, code first 331.82 (631.83) Lewy body disease, followed by 294.11 (F02.81) probable major neurocognitive disorder with Lewy bodies, with behavioral distur- bance. For probable major neurocognitive disorder with Lewy bodies, without behavioral disturbance, code first 331.82 (631.83) Lewy body disease, followed by 294.10 (F02.80) probable major neurocognitive disorder with Lewy bodies, without behavioral disturbance.
For possible major neurocognitive disorder with Lewy bodies, code 331.9(631.9) possible major neurocognitive disorder with Lewy bodies. (Note: Do not use the additional code for
Lewy body disease. Behavioral disturbance cannot be coded but should still be indicated in writing.)
For mild neurocognitive disorder with Lewy bodies, code 331.83 (631.84). (Note: Do not use the additional code for Lewy body disease. Behavioral disturbance cannot be coded but should still be indicated in writing.)
Major or mild neurocognitive disorder with Lewy bodies (NCDLB), in the case of major neurocognitive disorder (NCD), corresponds to the condition known as dementia with
Lewy bodies (DLB). The disorder includes not only progressive cognitive impairment tation); as well as hallucinations in other sensory modalities, depression, and delusions.
The symptoms ﬂuctuate in a pattern that can resemble a delirium, but no adequate under- lying cause can be found. The variable presentation of NCDLB symptoms reduces the like- lihood of all symptoms being observed in a brief clinic visit and necessitates a thorough assessment of caregiver observations. The use of assessment scales specifically designed to assess ﬂuctuation may aid in diagnosis. Another core feature is spontaneous parkinson- ism, which must begin after the onset of cognitive decline; by convention, major cognitive deficits are observed at least 1 year before the motor symptoms. The parkinsonism must also be distinguished from neuroleptic-induced extrapyramidal signs. Accurate diagnosis is essential to safe treatment planning, as up to 50% of individuals with NCDLB have se— vere sensitivity to neuroleptic drugs, and these medications should be used with extreme caution in managing the psychotic manifestations.
The diagnosis of mild NCDLB is appropriate for individuals who present with the core or suggestive features at a stage when cognitive or functional impairments are not of suf- ficient severity to fulfill criteria for major NCD. However, as for all mild NCDs, there will often be insufficient evidence to justify any single etiology, and use of the unspecified di- agnosis is most appropriate.