Neuropsychology of Lewy Body Disease in the Era of Biological Diagnosis: Cognitive and Neuropsychiatric Phenotypes Across the Disease Continuum

Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, yet it remains under-recognised and frequently misclassified as Alzheimer's disease (AD), as another non-AD dementia or as a primary psychiatric disorder. Its core clinical features - fluctuating attention, recurrent visual hallucinations, REM sleep behaviour disorder (RBD) and parkinsonism - rest on a cognitive and neuropsychiatric substrate that diverges from AD from the earliest stages, with disproportionate involvement of attention, executive control and visuoperceptual-visuospatial processing relative to episodic memory. The field is undergoing a decisive shift: alpha-synuclein seed amplification assays in cerebrospinal fluid and skin, alongside established imaging and autonomic markers, allow the underlying proteinopathy to be detected in vivo, including in prodromal and asymptomatic individuals. Consensus criteria for prodromal DLB and emerging biologically anchored staging frameworks reframe Lewy body disease as a continuum rather than a categorical dementia syndrome. Neuropsychology has yet to be repositioned within this new framework.Biological confirmation identifies which protein is present; it does not describe how a person thinks, behaves or functions. As diagnosis moves upstream of the dementia threshold, a gap is opening between biologically defined disease and its clinical expression - precisely the space neuropsychological and behavioural assessment is best equipped to occupy. This Research Topic aims to reposition neuropsychology as an essential layer of characterisation in Lewy body disease, rather than a tool displaced by biomarkers. We seek contributions that define the cognitive and neuropsychiatric signatures distinguishing DLB from AD, Parkinson's disease dementia and other non-AD dementias; that establish the predictive value of cognitive and behavioural phenotypes in prodromal stages, including isolated RBD and mild cognitive impairment with Lewy bodies; that examine how biomarker status maps onto cognitive and behavioural expression; and that characterise the phenotype of DLB-AD co-pathology. Equally, we ask what follows from this characterisation in practice: how the new diagnostic and staging criteria reshape neuropsychological assessment, and how cognitive and behavioural phenotyping should inform intervention, non-pharmacological management and carer support. The intended outcome is a phenotypically grounded account of the continuum that links assessment to clinical decision-making.Topics include, but are not limited to:- Differential cognitive and neuropsychiatric profiles of DLB versus AD, Parkinson's disease dementia and other non-AD dementias (frontotemporal, vascular and atypical parkinsonian syndromes)- Cognitive phenotypes in prodromal stages (isolated RBD, MCI with Lewy bodies) and their predictive value for phenoconversion- Correspondence between alpha-synuclein biomarkers (seed amplification assays, neuroimaging) and cognitive or behavioural expression- The neuropsychological signature of DLB-AD co-pathology- Implications of the new diagnostic and staging criteria for neuropsychological assessment.- Cognitive intervention, non-pharmacological management, functional outcomes and care implications across the Lewy body continuum. Biomarkers are welcome as context and validation, not as the primary focus: every submission should report a cognitive, behavioural or functional outcome. We encourage cohort studies, real-world clinical series, intervention studies, psychometric and test-development work, and rigorous syntheses. Topic editors: Rafael Villino-Rodríguez, Manuel Domínguez-Lizarbe, Miguel Germán Borda, Genoveva Montoya Murillo Source: https://www.frontiersin.org/research-topics/85938/neuropsychology-of-lewy-body-disease-in-the-era-of-biological-diagnosis-cognitive-and-neuropsychiatric-phenotypes-across-the-disease-continuum