Use supportive features of DLB fluctuations, structural imaging findings in DLB, and biomarkers for synucleinopathies such as DLB to frame the working diagnosis and next step; let it determine what to check next and how closely to follow the patient. Make structural imaging findings in DLB the checkpoint that determines whether you escalate testing, narrow the differential, or change treatment.

Advanced laboratory tests like alpha-synuclein RT-QuIC on cerebrospinal fluid or a skin biopsy, as well as objective smell testing demonstrating hyposmia, are also highly supportive; Diminished sense of smell, or hyposmia, is another highly supportive clinical clue; Yes, cholinesterase inhibitors are highly recommended and can significantly boost global thinking skills and day-to-day function; Clinical data supporting the use of memantine isn't quite as robust, but offering a structured therapeutic trial is considered a very reasonable step; These cognitive dips can be so profound that the individual becomes temporarily entirely unresponsive, a state that can easily be mistaken for a syncopal event