Objective: To systematically analyze the prevalence of prodromal symptoms in Lewy Body Dementia (LBD) across different continents, focusing on REM sleep behavior disorder (RBD), hallucinations, anxiety, depression, and subtle motor disturbances. This review aims to identify early, region-specific markers that may improve diagnostic accuracy and enable timely intervention.

Background: LBD is a progressive neurodegenerative disorder characterized by overlapping motor and non-motor features, which often complicates early diagnosis and treatment. Increasing evidence indicates that prodromal manifestations, including sleep disturbances, neuropsychiatric changes, and mild motor impairment, can precede classic motor symptoms by years. Geographic variability in symptom prevalence may reflect genetic, cultural, or healthcare-system differences, underscoring the need for region-specific early recognition strategies.

Method: We completed a focused narrative review of English-language studies (2012–2025) reporting prodromal LBD symptom prevalence. Six comprehensive studies were included: North America (n=116–143), Europe (n=166–892), and Asia (n=21–34). Data extracted included prevalence of RBD, hallucinations, anxiety, depression, and motor disturbances. Quantitative synthesis was performed to compare symptom distribution across continents.

Results: RBD prevalence ranged from 22% in European cohorts to 63% in large European cohorts (0.631), with Asian cohorts reporting 61.8% and 0%–57.9% in North America. Hallucinations were highest in Europe (up to 67%) and North America (20–45%), with lower reported prevalence in Asian cohorts (0–23.8%). Anxiety was reported in 44.8% of North American patients and 37.5% of Asian patients, whereas depression was 46% in North America, 41% in Europe, and 33% in Asia. Motor disturbances were most prevalent in North America (89%), followed by Asia (33–33.3%) and Europe (5–18%). These data highlight notable regional variation in prodromal symptom presentation.

Conclusion: Prodromal LBD features exhibit distinct continental patterns, with RBD and early neuropsychiatric symptoms as key early indicators. Recognition of these variations may improve early diagnosis and interventional strategies. Further research integrating standardized prodromal measures and into regional differences approach to treatment is warranted to enhance global diagnostic accuracy.

References: Wyman-Chick KA, O’Keefe LR, Weintraub D, Armstrong MJ, Rosenbloom M, Martin PK, Barclay TR, Barrett MJ. Prodromal dementia with Lewy bodies: evolution of symptoms and predictors of dementia onset. *J Geriatr Psychiatry Neurol.* 2022;35(4):527-534. doi:10.1177/08919887211023586.

Wyman-Chick KA, Ferman TJ, Weintraub D, Armstrong MJ, Boeve BF, Bayram E, Chrenka E, Barrett MJ. Distinguishing prodromal dementia with Lewy bodies from prodromal Alzheimer disease: a longitudinal study. *Neurology.* 2024.

van de Beek M, van Steenoven I, van der Zande JJ, Barkhof F, Teunissen CE, van der Flier WM, Lemstra AW. Prodromal dementia with Lewy bodies: clinical characterization and predictors of progression. *Mov Disord.* 2020;35(5):859-867. doi:10.1002/mds.27997.

Chiba Y, Fujishiro H, Iseki E, et al. Retrospective survey of prodromal symptoms in dementia with Lewy bodies: comparison with Alzheimer’s disease. *Dement Geriatr Cogn Disord.* 2012;33(4):273-281. doi:10.1159/000339363.

McKeith IG, Ferman TJ, Thomas AJ, Blanc F, Boeve BF, Fujishiro H, et al. Research criteria for the diagnosis of prodromal dementia with Lewy bodies. *Neurology.* 2020;94(17):743-755. doi:10.1212/WNL.0000000000009323.

Donaghy PC, McKeith IG. The clinical characteristics of dementia with Lewy bodies and a consideration of prodromal diagnosis. *Alzheimers Res Ther.* 2014;6(4):46. doi:10.1186/alzrt274.

McKeith IG, et al. Characterising the prodromal phase in dementia with Lewy bodies. *Parkinsonism Relat Disord.* 2023;107:105279. doi:10.1016/j.parkreldis.2023.105279.

Armstrong MJ. Advances in dementia with Lewy bodies. *Ther Adv Neurol Disord.* 2021;14:17562864211057666. doi:10.1177/17562864211057666.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cross-continental-differences-in-prodromal-symptoms-of-lewy-body-dementia-a-comparative-analysis-across-asia-europe-and-north-america/