Objective: To systematically review evidence on epidemiological and clinical differences in Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), in people from ethnic minorities.

Background: LBD is the second commonest degenerative dementia, but its burden and presentation in ethnic minorities remain poorly understood. Under-representation of these populations may mask differences in disease frequency and phenotype, with important implications for equity in care.

Method: Following PRISMA guidelines, we searched PubMed for studies published up to 30th August 2025 using predefined terms relating to LBD, ethnicity and clinical or imaging outcomes. Included studies reported ethnic or racial differences in LBD in prevalence, incidence, diagnosis, clinical features or imaging. Data were synthesised narratively due to heterogeneity in study designs, populations and outcome measures.

Results: Eleven studies met inclusion criteria, representing 3,552,393 participants from the USA, UK, Belgium, Israel and South Korea. These included approximately 2,934,817 White participants, 315,866 Black/African participants, 82,861 Asian participants and 186,135 Hispanic/Latino participants. Estimates of incidence and prevalence varied between studies: some cohorts suggested lower incidence of LBD in Black populations, whereas others reported higher rates of PDD among Black individuals with Parkinson’s disease. Clinicopathological studies suggested LBD is underdiagnosed in life in Black populations, with similar or higher Lewy body pathology at autopsy. Comparisons of clinical presentation between ethnic groups were scarce, with minority populations consistently under-represented. No studies directly compared imaging biomarkers, including MRI, PET, dopamine transporter imaging, MIBG scintigraphy, or EEG, between ethnic groups with LBD.

Conclusion: Evidence on ethnic differences in LBD is sparse and hampered by substantial under-representation of minority groups. This limits interpretation of apparent epidemiological and clinical differences and raises concern that LBD may be disproportionately missed or misclassified in some populations. Improved ethnicity reporting, targeted recruitment and inclusive biomarker studies are needed to reduce inequity and better define LBD across diverse populations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/differences-in-lewy-body-dementia-in-people-from-ethnic-minorities-a-systematic-review-of-epidemiology-diagnosis-clinical-features-and-imaging/