INTRODUCTION: We explored regional brain atrophy patterns and their clinical correlates in dementia with Lewy bodies (DLB). METHODS: In this multicentre study, we included a total of 333 patients with DLB, 352 patients with Alzheimer's disease (AD), and 233 normal controls and used medial temporal lobe atrophy, posterior atrophy, and frontal atrophy (GCA-F) visual rating scales. Patients were classified according to four atrophy patterns. RESULTS: Patients with DLB had higher scores on all the three atrophy scales than normal controls but had less medial temporal lobe atrophy than those with AD (all P values < .001). A signature hippocampal-sparing pattern of regional atrophy was observed in DLB. The magnetic resonance imaging measures showed 65% ability to discriminate between DLB and AD and marginally contributed to the discrimination over and above the core clinical features. DISCUSSION: The most common pattern of atrophy of DLB was hippocampal-sparing. Future studies should explore whether comorbid AD pathology underlies the atrophy patterns seen in DLB.

Centre for Age Related Medicine Stavanger University Hospital Stavanger Norway; Department of Radiology Stavanger University Hospital Stavanger Norway

Centre for Age Related Medicine Stavanger University Hospital Stavanger Norway; Institute of Psychiatry Psychology and Neuroscience King's College London London UK

Day Hospital of Geriatrics Memory Resource and Research Centre ICONE Strasbourg France

Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden; Department of Radiology Karolinska University Hospital Stockholm Sweden

Department of Neurology and Alzheimercenter VU Universisty Medical Center Amsterdam Netherlands

Department of Neurology Medical Faculty St Anne's Hospital and CEITEC Masaryk University Brno Czech Republic

Department of Neurology University Medical Centre Ljubljana Medical faculty University of Ljubljana Slovenia

Department of Neuroscience Imaging and Clinical Sciences and CESI University G d'Annunzio of Chieti Pescara Chieti Italy

Department of Neuroscience University of Genoa and Neurology Clinics Polyclinic San Martino Hospital Genoa Italy

Department of Neuroscience University of Padua Padua and Fondazione Ospedale San Camillo Venezia Venice Italy

Division of Clinical Geriatrics Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden

Division of Clinical Geriatrics Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden; Department of Neuroimaging Centre for Neuroimaging Sciences Institute of Psychiatry Psychology and Neuroscience King's College London London UK

Institute of Neuroscience Newcastle University Newcastle upon Tyne United Kingdom

Landspitali University Hospital Reykjavik Iceland

Memory Clinic Department of Neurology Charles University 2nd Faculty of Medicine and Motol University Hospital Prague Czech Republic; International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

Neurology Unit Department o Clinical and Experimental Sciences University of Brescia Brescia Italy

Norwegian Advisory Unit for Ageing and Health Vestfold Hospital Trust and Oslo University Hospital Oslo Norway

University College London London and Essex Partnership University NHS Foundation Trust United Kingdom

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