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The LBD Spectrum

Lewy body dementia (LBD) is not a single disorder but a spectrum of disorders involving disturbances of movement, cognition, behavior, sleep and autonomic function.

When diagnosing Lewy body dementias, please use the following ICD-9 code combinations:

* dementia with Lewy bodies (DLB)

331.82 – “Dementia with Lewy bodies”
294.1x - "Dementia" with the 'x' determined by presence ("1") or absence ("0") of behavioral disturbance.
(NOTE: Not all insurance carriers process 294.1x codes the same way. Confer with a billing expert before using this code.)

* Parkinson's disease dementia (PDD)

331.82 - "DLB, parkinsonism with dementia, Lewy body dementia, Lewy body disease"
332.0 - "Parkinson's disease"
294.1x - "Dementia" with the 'x' determined by presence ("1") or absence ("0") of behavioral disturbance.
(NOTE: Not all insurance carriers process 294.1x codes the same way. Confer with a billing expert before using this code.)

 

Parkinson's Disease Dementia

Parkinson’s disease (PD) is a common movement disorder that affects 1 in 100 individuals over the age of 60 and 4-5% of older adults over age 85 (approximately 1 million Americans).

  • Original descriptions of PD did not recognize cognitive problems as an important clinical feature. More recently, clinicians have come to realize that PDD occurs often and is among the most debilitating symptoms associated with disease progression.
  • It is estimated that each year up to 14% of PD patients over age 65 will develop at least mild dementia. In one study, almost 80% of PD patients developed dementia over an 8 year period, underscoring the high prevalence of dementia in PD.

 

Dementia with Lewy Bodies

In the past two decades, a related dementing disorder (DLB) has been described, characterized by signs and symptoms of parkinsonism, fluctuations in cognition and visual hallucinations.

  • Diagnostic criteria derived from the third consensus conference on DLB and published in 2005 were developed with the awareness that many patients with PD develop dementia, usually within ten years of the onset of motor symptoms. (Diagnostic criteria for PDD were only recently published in late 2007 and include essentially the same combination of symptoms, catalogued a bit differently.)
  • As there are no major clinical differences between DLB and PDD, a somewhat arbitrary diagnostic distinction was affirmed by the DLB consensus authors based on the temporal appearance of motor symptoms and dementia. That is, if motor symptoms precede dementia by more than 12 months, PDD is diagnosed, whereas, if dementia precedes or is concurrent with parkinsonism, then DLB is diagnosed.
  • Because DLB and PDD share many clinical (as outlined in the DLB criteria) and pathological (Lewy bodies) characteristics, both are classified as forms of LBD. 
  • The International Classification of Diseases-9 (ICD-9) code for DLB is 331.82


Source:  "Current Issues in LBD Diagnosis, Treatment and Research" by James E. Galvin, MD, Bradley F. Boeve, MD, John E. Duda, MD, Douglas R. Galasko, MD, Daniel Kaufer, MD, James B. Leverenz, MD, Carol F. Lippa, MD, Oscar L. Lopez, MD, representing the Scientific Advisory Council of the Lewy Body Dementia Association.  May, 2008

LBDA is grateful to the Lewy Body Committee of the Turner Family Foundation for providing financial support to send free resources on LBD to physicians and the families they serve.