Dementia with Lewy bodies (DLB) is a neurodegenerative disorder with a wide heterogeneity of symptoms, which suggests the existence of different subtypes. We used data-driven analysis of magnetic resonance imaging (MRI) data to investigate DLB subtypes. We included 165 DLB from the Mayo Clinic and 3 centers from the European DLB consortium and performed a hierarchical cluster analysis to identify subtypes based on gray matter (GM) volumes. To characterize the subtypes, we used demographic and clinical data, as well as β-amyloid, tau, and cerebrovascular biomarkers at baseline, and cognitive decline over three years. We identified 3 subtypes: an older subtype with reduced cortical GM volumes, worse cognition, and faster cognitive decline (n = 49, 30%); a subtype with low GM volumes in fronto-occipital regions (n = 76, 46%); and a subtype of younger patients with the highest cortical GM volumes, proportionally lower GM volumes in basal ganglia and the highest frequency of cognitive fluctuations (n = 40, 24%). This study shows the existence of MRI subtypes in DLB, which may have implications for clinical workout, research, and therapeutic decisions.

Center for Age Related Medicine Stavanger University Hospital Stavanger Norway

Day Hospital of Geriatrics Memory Resource and Research Center of Strasbourg Department of Geriatrics Hopitaux Universitaires de Strasbourg Strasbourg France

Department of Electrical Engineering and Computer Science University of Stavanger Stavanger Norway

Department of Neuroimaging Center for Neuroimaging Sciences Institute of Psychiatry Psychology and Neuroscience Kings College London London UK

Department of Neurology and Alzheimer Center VU University Medical Center Amsterdam Netherlands

Department of Neurology Charles University 2nd Faculty of Medicine Motol University Hospital Prague Czech Republic

Department of Radiology Mayo Clinic Rochester MN US

Division of Clinical Geriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden

Institute of Biomedical Research August Pi i Sunyer Barcelona Spain

International Clinical Research Center St Annes University Hospital Brno Brno Czech Republic

Medical Psychology Unit Institute of Neurosciences University of Barcelona Barcelona Spain

Quantitative Health Sciences Mayo Clinic Rochester MN US

Stavanger Medical Imaging Laboratory Department of Radiology Stavanger University Hospital Stavanger Norway

UCL institutes of neurology and center for medical image computing London UK

University of Strasbourg and French National Center for Scientific Research ICONE Strasbourg France

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Cerebrovascular and Alzheimer's disease biomarkers in dementia with Lewy bodies and other dementias

Sex differences in brain atrophy in dementia with Lewy bodies