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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Ian Rose via FACBot (talk) 31 May 2020 [1].

Dementia with Lewy bodies

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Nominator(s): SandyGeorgia and Colin°Talk

Who did not love Robin Williams? So, if you think you know what condition Robin Williams had when he died, there will be a quiz at the end of this article, where you will learn more new terms than you ever wanted to know. Dementia with Lewy bodies (DLB) has been a two-year collaboration involving medical editors working with FAC's own art cabal. Research and factoids chunked in by me; copyediting and prose smoothing mainly by Outriggr with considerable help from Ceoil and Yomangani; oversight, clarity and copyediting added by fellow medical editor, co-nom Colin; and medical feedback added from Adrian J. Hunter, Casliber, LeadSongDog and Doc James. They should all be co-noms! Sourcing is up to MEDRS standards, with the latest secondary reviews incorporated, and RexxS provided an accessibility review. SandyGeorgia (Talk) 12:11, 6 May 2020 (UTC)[reply]

Image review (and two more things)

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Disclaimer: I've worked with SandyGeorgia on other articles, so I am not entirely disinterested in this FAC

  • File:PBB Protein APOE.jpg: I distinctly remember that this kind of image is freely licenced, but I am not sure if the licence given is the correct one.
  • I am not so sure if the haloperidol caption is endorsed by the source.
  • Ditto for the PET caption.
  • Regarding the Robin Williams image, did he have a case of Lewy body dementia or of Dementia with Lewy bodies? Sources sound like the former, but this is an article about the latter. Jo-Jo Eumerus (talk) 12:41, 6 May 2020 (UTC)[reply]
  • (Non-image) There is a "Articles containing potentially dated statements from 2019" tag, is it an issue?
  • (Non-image) "Additional risk factors for rapid conversion of RBD to a synucleinopathy include impairments in color vision or the ability to smell, mild cognitive impairment, and abnormal dopaminergic imaging.[22]" is in a causes section, but isn't that really more a warning sign than a risk factor?

All images are well placed and seem pertinent. Jo-Jo Eumerus (talk) 12:41, 6 May 2020 (UTC)[reply]

Very good catches, Jo-Jo!
SandyGeorgia (Talk) 13:47, 6 May 2020 (UTC)[reply]
Also, Colin does speak images, and he might address the Protein APOE licensing question. SandyGeorgia (Talk) 14:03, 6 May 2020 (UTC)[reply]
The source says "Molecular images from RCSB PDB Structure Summary pages are available under the same conditions" which "are free of all copyright restrictions and made fully and freely available for both non-commercial and commercial use". So that does sound like a release into PD, which is what the template says. Although they do say "Users of the data should attribute the original authors of that structural data.", which might sound like an attribution requirement, this isn't a feature of a copyright licence the way CC BY-SA is, and so, is a non-copyright restriction that applies to users of the databank website only (and which the uploader complied with: we do attribute the original authors). -- Colin°Talk 14:35, 6 May 2020 (UTC)[reply]
I'm not convinced an attribution requirement would be considered a non-copyright restriction - seems more like a specialized license. Nikkimaria (talk) 20:22, 6 May 2020 (UTC)[reply]
Could all of you please translate for me? What do I need to do? SandyGeorgia (Talk) 20:54, 6 May 2020 (UTC)[reply]
Sandy: we don't agree ;-) . Bottom line is the image can be used either way, it's just a matter of whether the current tag is acceptable (Colin's position - Colin, please correct me if I've misinterpreted) or whether it ought to use something a bit more nuanced (my view). Nikkimaria (talk) 21:29, 6 May 2020 (UTC)[reply]
Continued at talk page. SandyGeorgia (Talk) 12:36, 7 May 2020 (UTC)[reply]
Resolved on talk; although that image was apparently deemed acceptable by Commons admins, Ajpolino has uploaded a new and better resolution image, which Colin has installed in the article. SandyGeorgia (Talk)

Support by Ceoil

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My contribution is mentioned above, though it wasn't much. This support is narrowly based on accessible writing and the article's overall clarity for laypersons and from the POV of family readers looking up post diagnosis. Not an easy goal if the article is still to be of value and integrity to experts, but having watched for a number of years as that balance was struck, am confident that it is achieved here without compromising meaning or precision. Note, all my many quibbles were dealt adequately, and with grace, on the talk page. Ceoil (talk) 19:17, 10 May 2020 (UTC)[reply]

Comments Support by From Hill To Shore

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I am putting this here as a placeholder while I read the article. I note that the article appears to have skipped the GA stage, so I may bring up some points that would normally be considered before an article reaches FAC. For the information of the co-ordinator closing this discussion, I have no previous experience with medical articles, other than as a general reader. Hopefully I can provide an alternative perspective on the article. From Hill To Shore (talk) 22:18, 13 May 2020 (UTC)[reply]

  • Lead section: I note there are some references in the lead section. In other articles I have read, the text is cited where it appears in the main body and the summary in the lead is left without citations. Is there a reason for doing it differently here?
  • See MOS:LEADCITE (The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus. Complex, current, or controversial subjects may require many citations; others, few or none. The presence of citations in the introduction is neither required in every article nor prohibited in any article.) In this case, while technically nothing in the lead required citation, and my preference would be to eliminate all lead citations, consensus on article talk was to cite hard data (numbers, dates), but to also cite the surprising (likely to be challenged?) fact that the use of antipsychotics can lead to death, and medication information. This was a compromise developed on talk after some contention about what to cite, where I disagree with citing leads. This is not my choice, but a matter of consensus, as the guideline specifies. SandyGeorgia (Talk) 01:53, 14 May 2020 (UTC)[reply]
  • Placement of citations and notes: I notice throughout the article that some citations and footnotes are placed directly after a word, rather than after the next punctuation mark. Some of the examples in the article are covered by the dashes and parentheses exceptions, but others are not. See MOS:CITEPUNCT.
  • The article follows MOS:CITEPUNCT, which is ref placement after the text it is citing, and after punctuation where that occurs. You may be misreading CITEPUNCT? In the "olden days" of Wikipedia (when the citeref style and inline citations were new), people did not know whether to place ref tags before or after punctuation, so it was standardized to after (except for dashes), and we even had scripts to go around fixing them because people so often put punctuation after ref tags. CITEPUNCT doesn't say to always place ref tags after punctuation; it says to place ref tags after the text cited, but also after punctuation when that occurs. SandyGeorgia (Talk) 01:53, 14 May 2020 (UTC)[reply]
  • Lists (Core features & Supportive features sections): I'd suggest adding a citation after every bullet as that will make it easier to confirm each item is verifiable and identify if someone inserts an unsourced item on the list at a later stage.
  • Overlinking: Linking once in the lead, once in the article body and perhaps once in the infobox are the limit. I'll post below any examples I find that go beyond that.
  • In an article with many complex terms, such as this one, it is acceptable to occasionally relink in different sections. There should not be any more of this, and those few for complex words seemed necessary and warranted. (At least my co-writers, who were not medical editors, thought those few extra links were helpful for them.) MOS:REPEATLINK allows for this. I did remove one that was closer to the first occurrence;[5] but we have to remember the reader first (that's why guidelines aren't policy) and synucleinopathy is a big word! SandyGeorgia (Talk) 02:06, 14 May 2020 (UTC)[reply]
  • Dementia Cognitive Fluctuation Scale: Should this be a term that deserves its own article at some point? If so, I'd advise that you make it a red link. Normally, any term that an author thinks is important enough to capitalise but doesn't repeat again in the article, makes me think that it is an important topic that needs to be explained elsewhere. Alternatively, it could be something that should be a lower case term for the purpose of this article. If it isn't getting its own article and is stated here that it isn't a validated diagnosis tool, it may be useful to provide a little background. Who developed it, how old is it, how widely adopted is it?
  • In re-reading the sources with the intent to stubbify and link an article for the Scale, I decided to remove the text instead, because it is still a very rarely used test, and none of the newer reviews even mentioned it.[6] Differential diagnosis with Vascular dementia isn't that complicated, and didn't warrant its own section. SandyGeorgia (Talk) 01:53, 14 May 2020 (UTC)[reply]
  • Notes: I'd suggest using {{notelist|32em}} so that your notes and references sections align. This will also clear out a large area of whitespace in your notes section.
  • Sources & References: The style is a little contradictory. In sources you have named one journal and then cited it in the reference section. All other journals are then named in the references. I'd suggest naming all journals in the sources and then citing them in the references. This will also have the benefit of shrinking your reference section as you have duplicated some sources, such as Gomperts SN (April 2016) and Goedert M (2017).
  • The one source listed is a book (not a journal article)-- the only book used-- so is listed separately as a general Source, so that page numbers can be cited in short form within References. The citation style is that books are listed separately, with page numbers in short-form citations. Since this confused you, it could confuse others, so I moved the Sources to Book sources, under the References, as I did at Tourette syndrome and other articles; I hope that is clearer? There are two different Goedert articles, and the two Gomperts listings are different (one is to a Table that is at a different URL). SandyGeorgia (Talk) 02:10, 14 May 2020 (UTC)[reply]
  • Ah. I had thought it was a journal as it had a doi reference. The Gomperts link is identical but you have included a description of where to find the information in the title/link text; I'd advise using |at=Table 4-6 in the template if you aren't going to follow my suggestion below. From Hill To Shore (talk) 18:47, 15 May 2020 (UTC)[reply]
  • Ah. I hadn't realised the two fields would contradict each other. As per the discussion below, if the current citation style is being retained, my comment above is a bit of a moot point. Feel free to ignore it. From Hill To Shore (talk) 19:47, 15 May 2020 (UTC)[reply]
  • References: I am assuming the Ian G. McKeith of Newcastle University that is named in some references is the same Ian McKeith of Newcastle University named in other references and external links. If this can be confirmed, I'd suggest applying a consistent name throughout.
  • You also have "McKeith I, Fairbairn A, Perry R, Thompson P, Perry E (September 1992)" and "Connors MH, Quinto L, McKeith I, et al. (November 2017)". If you can confirm this is the same person then it would be good to use consistent naming in the article. This is a minor point though, so don't worry if you can't confirm it is the same person. From Hill To Shore (talk) 18:47, 15 May 2020 (UTC)[reply]
  • References: A lot of calls are made to individual citations that cover quite a few pages. For example, the current citation 1 is called 56 times but is a document 12 pages long. Is it possible to break this citation down into more manageable chunks? This will allow easier verification as readers won't have to search through all 12 pages to find the supporting information. I'd raise the same issue for the other citations that have a large number of pages (Gomperts SN April 2016 appears to have 28 pages). The current method doesn't appear to meet the level of precision required by WP:CHALLENGE.
  • See the discussion at WT:FAC here, and let me know what you think. (Basically, if the need for page ranges on journal articles is held, every medical FA will need to be defeatured, and we will have no more medical FAs; this is just not standard practice in medical publishing.) The Gomperts article appears longer than the others because it is chock full of tables, that I rarely used. SandyGeorgia (Talk) 01:53, 14 May 2020 (UTC)[reply]
  • I've been mulling over how to respond to this the last couple of days but, unfortunately, I can't agree. You requested input from people outside of the medical field to provide an alternative perspective. From the perspective of a reader and editor of Wikipedia, we must be helpful to those who want to verify the information in our articles by directing them to relevant parts of a publication (pages, chapters, sections or paragraphs). Whether the medical profession choose to cite parts of a published document is not relevant here. We are not writing an article for medical professionals; we are writing a summary of a topic for a general audience and directing them to more detailed materials for further study. Whether other stuff exists on other articles is not relevant here. Using a more precise citation style doesn't automatically mean that you should remove FA status from other articles. That is a matter of consensus and is also related to the length of the journals being cited (if the journal article is only a few pages long, that would be a reasonable range for a general book citation). After careful thought, I won't be able to support this article that uses such an imprecise citation style with long journal articles, however, as you say it is the result of consensus, I won't object to promotion either. I will leave this note for you to consider and abstain from the decision if the current style remains. From Hill To Shore (talk) 18:47, 15 May 2020 (UTC)[reply]
  • Thanks, From Hill To Shore; this is precisely the kind of response that I can say was helpful from my FAC delegate days. It gives the Coords something upon which to base the decision. If you want to explore this further, we can take it to the talk page of this FAC-- that is, if you feel strongly about specific sources, or all of them. But since every medical article used this style-- yea, we'd be needing to re-do every single medical FA, and every single medical article. Best, SandyGeorgia (Talk) 19:11, 15 May 2020 (UTC)[reply]
  • Thanks for the offer but I don't have the time in my personal life to try to convince an existing consensus of editors to change its mind. I'll probably flag this issue up again in future but it will be more of a passive argument; "I think there is a better way to do this but I am not going to stop you." From Hill To Shore (talk) 19:47, 15 May 2020 (UTC)[reply]
  • @From Hill To Shore:, you converted me. It's more important that we have good reviewers at FAC, than it is to have an FA that subscribes to the odd way that medical articles have always been written without page ranges. Twelve hours in, and I am less than halfway finished converting to page numbers at User:SandyGeorgia/sandbox5. Bad timing for this, but I should be able to get this finished in a day or two. But I hope no one asks me to convert all the older medical FAs! Best regards, SandyGeorgia (Talk) 03:30, 17 May 2020 (UTC)[reply]

I still have a lot to work through. I'll add more notes over the next few days. From Hill To Shore (talk) 00:21, 14 May 2020 (UTC)[reply]

@From Hill To Shore:, thanks for engaging! Is it easier for you if I answer and work on these parts now, or would you prefer I wait until you are done? SandyGeorgia (Talk) 00:32, 14 May 2020 (UTC)[reply]
I don't mind either way. Whatever works for you. From Hill To Shore (talk) 00:50, 14 May 2020 (UTC)[reply]
@From Hill To Shore:, thanks for the first batch: see my comments interspersed. (Feeling like a hypocrite because I used to scream about interspersed comments, but I found it too complicated to add all of mine below in one post-- hope you don't mind me chopping it up like this.) SandyGeorgia (Talk) 01:53, 14 May 2020 (UTC)[reply]
@SandyGeorgia: No problem. Every review I have been involved with seems to follow a different style. I've added some follow up comments above. Unfortunately the imprecise citation style is a deal breaker for me here. As noted above, I have given this a lot of thought and decided that I will abstain from the !vote if the current style remains. I have registered my concern but I don't see that I should derail a promotion in the face of another consensus on style. From Hill To Shore (talk) 18:47, 15 May 2020 (UTC)[reply]
I respect and appreciate that approach; you're a very good reviewer, by the way :) SandyGeorgia (Talk) 19:12, 15 May 2020 (UTC)[reply]

Thanks for breaking down the citations. I'll take another look at the article now. I like Seppi333's numbered review style; I think I'll borrow it for future reviews.

  1. Signs and symptoms: "Several areas of functioning[a] can be affected by Lewy pathology," I'd suggest moving footnote [a] to after the comma. The footnote is about the functions affected, so the whole clause is relevant. The current placing of the footnote breaks the flow of the narrative and you then have to read beyond the footnote to understand what it is related to.
    Done, [9] SandyGeorgia (Talk) 01:27, 25 May 2020 (UTC)[reply]
Reference review
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  1. Classification: "that is, it is characterized by degeneration of the central nervous system that worsens over time." has no citation.
  2. Classification: other than the part sentence above, all of the information in this section appears to be covered by the sources. All sources in this section are available online and have been verified.
  3. Signs and symptoms: Armstrong (2019), Tousi B (October 2017) Kosaka K (2017) are behind paywalls and I can't check them; specific pages or sections are cited though, so can be verified by others.
  4. Signs and symptoms: In footnote [a] "substantia nigra" is not mentioned by the online source, although the more generic "basal ganglia" is mentioned. Similarly, I can't spot a mention of hypothalamus. Are these covered by the source behind the paywall (Kosaka K)?
  5. Signs and symptoms: Current citation 20, "Donaghy PC et al. (2015), p. 262." needs to be changed to "Donaghy PC et al. (2015), p. 262, 264." as dizziness is not listed as a specific early symptom until the later page.
  6. Signs and symptoms: Current citation 7, 'Taylor JP et al. (2020), sec. "Sleep disturbances".' needs to be changed to 'Taylor JP et al. (2020), sec. "Noctural sleep disturbances".' Daytime sleepiness has a separate section.
  7. "Essential feature", "Core features" & "Fluctuating cognition, alertness or attention" sections: all clear.

I have quite a lot of the article to go through, so I'll add more in the coming days. From Hill To Shore (talk) 23:54, 24 May 2020 (UTC)[reply]

@From Hill To Shore:, yes, I too prefer numbers, so I don't have to chop your post, but can reference it. Here are the changes I made to accommodate your lists above: [10]
On 1, that is a repeat of the basic definitions (neurodegeneration is degeneration in nervous system and progressive is worsening over time-- citing that would be citing basic definitions that are given in the hyperlinks).
On 4, you are correct that hypothalamus came from Kosaka, so I moved that portion to that citation, and replace the more specific substantia nigra with the generalized basal ganglia, to maintain the general level of detail.
On 5, actually Donaghy 262 does mention and describe dizziness, but the better description of the whole bit of text is on 264, so I changed that citation from 262 to 264.
Item 6 presents a problem. I used the original journal (Lancet) publication, although I provide the courtesy URL from the author. The final publication combined those two sections (Noctural v Daytime) in to one section, named Sleep disturbances. I have added an explanatory note explaining the difference from the online courtesy link and the actual article, which is what I used to source, and removed the courtesy link from the citation to a separate note. (This was not a problem until I added page nos-- I hope this is a satisfactory resolution.) SandyGeorgia (Talk) 15:19, 25 May 2020 (UTC)[reply]
Hi From Hill To Shore, did you want to add anything? Cheers, Ian Rose (talk) 07:57, 31 May 2020 (UTC)[reply]
@Ian Rose: Thanks for the ping. I had intended to review all of the references but my work has taken up too much time lately. I'm satisfied with everything I have checked up to this point so I will change this to support. From Hill To Shore (talk) 12:27, 31 May 2020 (UTC)[reply]

Comments by Seppi

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  • Support promotion based upon my earlier pre-FAC read-through and the work Sandy did when actioning my feedback. I haven't read through the entirety of the current revision, but this article looks to be on par with other medical FAs that cover diseases. It's pretty clear that the current revision is the result of many hours of research and editing. Will go through it again this month and review/fix any issues with the MOS compliance and maybe review 1 or 2 of the other criteria while I'm at it.

@SandyGeorgia:: Thanks for making those changes. Attributing medical advice to a source might seem a bit pedantic; I just don't think Wikipedia itself should be telling people how to live their life.

A few random questions/suggestions following my read-through of several sections in the current version:

  1. The article mentions that a definitive diagnosis requires an autopsy, so I assume that entails some form of molecular diagnosis. I'm not sure what's involved in diagnosing it post-mortem, but couldn't a definitive diagnosis also be accomplished via a brain biopsy? I realize that isn't a common practice for most brain diseases since brain biopsies necessarily cause some minor brain damage.
    Hi, Seppi! Thanks for weighing in! I cannot recall seeing any mention of brain biopsy (while one is alive) as a method of diagnosis; that could be related to attention shifting (since 2017) to the exciting possibility of alpha-synuclein in skin biopsies as a biomarker. Your query did lead me, though, to find and fix an oversight. [11] If you are aware of any use of brain biopsy to determine LBDs, please point me at them! SandyGeorgia (Talk) 12:32, 14 May 2020 (UTC)[reply]
  2. The article mentions that melatonin is used to help with sleep since a number of somnogenic drugs (e.g., benzos/diphenhydramine) are contraindicted. At the very end (Research directions section), the article mentions that widespread neuroinflammation occurs. Based upon your reading of the sources, does neuroinflammation play a central role in the disease pathophysiology or mediate some of the symptoms of the disorder? The reason I ask is that very high dose melatonin (e.g., 200 mg) has rather pronounced anti-inflammatory effects in the CNS and periphery (e.g., see [12]) via signaling cascades that it initiates through MT1/MT2 receptors (NB: those are GPCRs, so the mechanism involved is similar to how NIACR1 works, but differs from COX enzyme inhibition by NSAIDS and corticosteroids like cortisol binding to an anti-inflammatory nuclear receptor). Getting to my point: if neuroinflammation mediates disease progression or symptoms, it would probably be worthwhile to mention any preclinical research or clinical evidence involving the use of melatonin for that purpose.
    I can't find any mention of melatonin to that effect, Seppi, but searching for it is made complicated by the terminology of the LBDs, and also by the volume of information that comes up re melatonin and RBD. I suppose if anything significant about melatonin wrt the neuroinflammation response existed, it would have been mentioned in one of the reviews cited. If you have any suggestions or can find anything, please let me know? SandyGeorgia (Talk) 13:06, 14 May 2020 (UTC)[reply]
  3. Assuming the cited sources are discussing the reuptake of dopamine by dopamine transporters (as opposed to the uptake/internalization of the dopamine transporter itself, e.g., as shown here), you might want to change all the phrases "dopamine transporter uptake" in the article to something like "dopamine transporter activity" (implies dopamine uptake), "dopamine reuptake", or "dopamine uptake by DATTooltip dopamine transporter" to avoid ambiguity.
    I thought I had covered that by linking on the first occurrence to DAT, here ... The indicative diagnostic biomarkers are: reduced dopamine transporter uptake ... all sources use those words exactly. I am not sure what other change you are suggesting as I do link to DAT? SandyGeorgia (Talk) 12:51, 14 May 2020 (UTC)[reply]
  4. Regarding this paragraph in the pathophysiology section: A proposed pathophysiology for RBD implicates neurons in the reticular formation that regulate REM sleep. RBD might appear decades earlier than other symptoms in the Lewy body dementias because these cells are affected before other brain regions.[10] The underlined phrase refers to the ascending reticular activating system; you might want to just link to that topic directly instead of reticular formation.
    Done, [13] thanks! (Will ping you when done with #2 and #3.) SandyGeorgia (Talk) 12:37, 14 May 2020 (UTC)[reply]

If you want me to action what I mentioned in 3 and 4 above, LMK. Seppi333 (Insert 2¢) 03:01, 14 May 2020 (UTC)[reply]

@Seppi333:, thanks so much; responses interspersed above, awaiting further! SandyGeorgia (Talk) 13:07, 14 May 2020 (UTC)[reply]

Carabinieri

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Hi, let me preface this by asking for forgiveness for my ignorance of all things medical. I'll review this mainly by looking at how understandable the article is to a lay audience. I think the article mostly does a remarkably good job of this, but I do have a few comments and questions:

  • I was a little confused by the "usual onset" item in the infobox. It says "After the age of 50, typically 76". I found this a little strange since "typical" is just a synonym for "usual". I understand from the body of the article that 76 is the median age. I would suggest changing this to "After the age of 50, median of 76" or leaving out the 76 part. I have another question on this: According to the body of the article, symptoms usually appear after the age of 50. Doesn't that mean that people will typically have had the disease at a younger age? Or is there not a meaningful distinction between onset of disease and onset of symptoms in this context? The "Essential features" section seems to imply that the disease typically begins before the age of fifty, but dementia symptoms only appear after.
  • I changed the infobox per your suggestion. And I removed the mention of age 50 from the Essential features section, because its appearance there, in the context of the timing of onset of dementia, was giving the wrong impression (glad you caught that!).[14] While it is now known that RBD can precede DLB by decades (indicating that Lewy bodies may be forming long before other symptoms appear), it was not intended to say that the disease is typically present before age 50. Now the 50 to 80 typical symptom onset is covered in Epidemiology. Onset of symptoms vs. onset of disease is tricky for a condition like DLB, because remember, DLB can only be definitively diagnosed by autopsy. We can't really know when "disease" onset. So, in the context of DLB, onset of symptoms refers to when the core features typically appear, and dementia (the essential feature) usually appears after other symptoms. I hope that by moving the 50 out of Essential features, your confusion is cleared up. SandyGeorgia (Talk) 18:55, 21 May 2020 (UTC)[reply]
  • "Other core features are visual hallucinations; marked fluctuations in attention or alertness; and parkinsonism (slowness of movement, trouble walking, or rigidity)." Is there any reason for the semicolons? Wouldn't commas do?
  • "DLB is dementia that occurs with "some combination of fluctuating cognition, recurrent visual hallucinations, rapid eye movement (REM) sleep behavior disorder (RBD), and parkinsonism starting with or after the dementia diagnosis", according to Armstrong (2019)" Is there any particular reason for the quote and the attribution to Armstrong? Is this a controversial description? If not, wouldn't it be better to paraphrase it and state it in Wikipedia's voice?
  • I thought it was the most elegant summary I had seen, and I couldn't paraphrase it better myself. If it troubles you a lot, I'll give it a try, but I fear it won't be pretty :) There is so much going on with DLB that I thought Armstrong did a great job of getting it down to a sentence. SandyGeorgia (Talk) 19:01, 21 May 2020 (UTC)[reply]
  • I have the same questions about this sentence "According to the 2017 Fourth Consensus Report of the DLB Consortium, a dementia diagnosis is made after a "progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities". There are several additional quotes throughout the article I think should probably be paraphrased.
  • I think quoting vs paraphrasing is always a judgement call or a matter of personal stylistic preferences. I generally prefer as few quotes as possible, but I certainly wouldn't insist on anything. You're probably the best judge of whether the quotes that are left are the best way to express those things.--Carabinieri (talk) 12:30, 23 May 2020 (UTC)[reply]
  • The "Essential features" section mainly compares DLB with Alzheimers, while in other sections the comparisons are mostly to Parkinson's. Is there a reason for this? Maybe I'm just overlooking something obvious.
  • The only essential feature is dementia, and DLB is most often confused with the better known Alzheimer's. The effect on memory with DLB is different from that with Alzheimer's. While the rest of the symptoms (non-memory related) have to be distinguished from other conditions. I think the confusion here was because of the section ordering; I moved the differences in memory between AD and DLB to the differential diagnosis section, which I hope helps resolve this. [18] SandyGeorgia (Talk) 00:15, 22 May 2020 (UTC)[reply]
  • "These core features were determined based on their "diagnostic specificity and the volume of good-quality evidence available" Could this be explained a little more? I really wasn't sure what this means.
  • Executive function is mentioned several times. Maybe this term could be briefly explained?
  • I'm hoping you'll take another look at the three suggestions for more explanation (heritability, parkinsonism and executive function) with several things in mind. Heritability was a bit of a mess, so I added a sentence there, but the parkinsonism and executive function articles already do good jobs at explaining those. This article is already almost 8,000 words, and to bring in those definitions might add unnecessary length and defeat the purpose of wikilinks. I understand your confusion about heritability because the article lead was so hard to follow, but I'm reluctant to add three more paragraphs to this article of definitions that are available via wikilinks. Please let me know what you think. If I am to add them here, I won't use the old sources in the current articles, so will have to do some research to find the latest MEDRS-sourced definitions. SandyGeorgia (Talk) 00:22, 22 May 2020 (UTC)[reply]
  • I understand that readers will have widely varying levels of familiarity with the topic so making the article appealing to a broad audience is tricky. I personally prefer not to have to follow wikilinks when reading an article, but obviously articles can't explain everything tangentially related to their topics. I'll defer to you on whether these terms can be further explained without bloating up the article.--Carabinieri (talk) 12:30, 23 May 2020 (UTC)[reply]
  • More of a personal opinion: I'm not a big fan of quote boxes in general unless they're used to present a really memorable quote that can't be incorporated into the prose. I'd probably remove both quote boxes in this article, but like I said that's just a personal opinion.
  • Generally, I agree. But those are two highly significant factors in DLB (one, the importance of educating physicians, patients and caregivers about the life-threatening consequences of anti-psychotics, and two, the game-changer in terms of diagnosis that polysomnography-verified RBD is); I hope you won't mind if these two are kept. SandyGeorgia (Talk) 19:25, 21 May 2020 (UTC)[reply]
  • Parkisonism is linked three times in the body and once more in the lead. Also, my understanding of the article is that there is a distinction between Parkinson's disease and parkinsonism as a set of symptoms that are not specific to that disease. Is that correct? Maybe this could be made a little more explicit in the article?
  • Earlier copyeditors felt the extra links were warranted (because of the dense terminology in this article), but you're the second reviewer to mention this, so I have reduced the links.[20] Yes, parkinsonism is a thing unto itself, present in numerous different conditions. I feel like it's well covered at the parkinsonism article, and hope we can avoid deviating to cover all of that here. If you feel strongly about it, I will have to find a source once I have a better internet connection to work it in here, as I don't have access to the sources at the parkinsonism article. SandyGeorgia (Talk) 19:44, 21 May 2020 (UTC)[reply]
  • "Visual hallucinations are defined by Pezzoli et al. as "well-formed images perceived without the presence of real stimuli". I've asked for a lot of additional explanations, but I think this one might be kind of unnecessary since that seems to be a description of what laypeople will think of when they hear "visual hallucinations".
  • "The heritability of DLB is thought to be around 30%." Could this be explained further? Does this mean that 30% of the children of a DLB patient will typically contract the disease eventually? Or what does this number mean? I've seen numbers like this before and always wondered what they mean exactly.
  • According to MOS, "Genes (but not proteins encoded by genes)" should be in italics. Is Apolipoprotein E a gene or a protein? According to the article that is linked in the article, it's the latter, but maybe I'm missing something. Also is there a reason to link "APOE" rather than "Apolipoprotein E"?
  • "Other risk factors for developing DLB include having an affected family member, being over the age of 50, and having REM sleep behavior disorder (RBD)" I have a few questions about this sentence. Isn't the first part ("include having an affected family member, being over the age of 50") already implied by the first part of the section? Is this saying that RBD is a cause of DLB rather than a sign of the disease?
  • Risk factors are things that increase one's chances of having a condition. So sometimes genetic (affected family member), over age of 50 (yes, this is redundant because we've already said it elsewhere, but we still have to list all the risk factors), and RBD because 94 to 98% of people with RBD progress to a synucleinopathy, such as DLB. The relationship between risk factors and causes isn't always clear, and can differ from one factor to another. SandyGeorgia (Talk) 00:41, 22 May 2020 (UTC)[reply]
  • "Additional risk factors for rapid conversion of RBD to a synucleinopathy include impairments in color vision or the ability to smell, mild cognitive impairment, and abnormal dopaminergic imaging" Again, these sound more like symptoms of the disease, rather than potential causes, but I may be misunderstanding something.
  • When the precise cause isn't known, we end up talking about risk factors that contribute to the chance of having a condition-- even if we don't know why. I'm not sure if that answers your question SandyGeorgia (Talk) 00:44, 22 May 2020 (UTC)[reply]

I'll stop here for now. I'll try to find the time to go through the rest of the article later. I hope these comments and questions are helpful and that you won't hold my ignorance against me.--Carabinieri (talk) 17:09, 21 May 2020 (UTC)[reply]

@Carabinieri:, no apologies needed-- this is a very useful review, and most appreciated. It may take me a bit longer than usual to work through these as I am in the car on the long drive to the cabin, editing from an iPhone hotspot. And I forgot to bring the sources with me, so have to access each one from a slow connection :( I will ping you when I'm through all of these-- possibly not 'til tomorrow. Best, SandyGeorgia (Talk) 18:45, 21 May 2020 (UTC)[reply]
No hurry, I have a lot on my plate with work and other things, so I may be a bit slow to answer.--Carabinieri (talk) 18:49, 21 May 2020 (UTC)[reply]
@Carabinieri:, I got through those, implemented many of your suggestions but not all, and left some answers to your question-- which may or may not help. SandyGeorgia (Talk) 00:44, 22 May 2020 (UTC)[reply]

Thanks for your responses. Your changes and responses are very helpful. I'm still a little confused about the last paragraph of the causes section. My understanding is that the first two paragraphs describe what leads to the formation of those protein deposits that cause LBD. The last paragraph (other than the age part) seems to describe symptoms that are effects of the disease and are therefore indicative of whether an individual has the disease. Couldn't, by the same token, all the symptoms in the preceding section be listed as risk factors since they are also indicative of someone having LBD? I guess what I'm hoping for is a clear-cut distinction between causes and effects, but maybe that kind of distinction doesn't make sense in this context.

This text from risk factor may help: Risk factors or determinants are correlational and not necessarily causal, because correlation does not prove causation. The genetic risk factor was already covered in the first para, so I removed it here, and re-jigged this paragraph thusly. Risk factors are things that determine an increased risk of having DLB. So of the things listed, that can be (rarely) genes, most likely age, and RBD because 94 to 98% of RBD progresses to a synucleinopathy. The reason all the other symptoms aren't risk factors is they can (and often are) associated with other conditions. There is no stand-alone evidence that fluctuating attention, for example, means one has or will get DLB-- one could have ADHD or depression or some other condition that yields fluctuating attention. Ditto for parkinsonism: one could have parkinsonism due to a large number of conditions, and DLB is not the main one-- meaning having parkinsonism is a symptom but not a symptom that has been shown to be highly correlated with the development of DLB. Likewise, visual hallucinations can be due to many other conditions, and having them (stand-alone) has not been shown to be highly predictive of DLB. Now, if one has ALL of the symptoms (or MANY of the symptoms), then those point to a diagnosis, but the only one alone that per se increases the risk of one developing DLB is REM sleep behavior disorder, as it has been demonstrated that about half of people with RBD will convert to DLB. I hope this makes sense; I don't think it's something that can be worked into the article any more than it already is, so I hope this suffices. (Still working on definitional things.) SandyGeorgia (Talk) 20:41, 23 May 2020 (UTC)[reply]

I'll review the rest of the article the same way I did the first sections:

  • I have two questions about the pathophysiology section: First, are acetylcholine-producing neurons and dopamine-producing neurons the only brain cells affected by LBD? Or are those just the only cells where the effect of LBD can be linked to specific symptoms? Second, about this sentence: "A proposed pathophysiology for RBD implicates neurons in the reticular formation that regulate REM sleep" Is this sentence saying that this theory proposes that LBD starts in the retical formation and then spreads to the rest of the brain? Or is it a brain-wide process that just happens to affect the reticular formation first?
  • I have to admit that most of the diagnosis section went over my head, but that probably can't be helped. I guess it's probably just a complicate technical matter that can't be easily explained to a layman. The only thing I can think of that might be helpful is explaining the term biomarkers (as opposed to symptoms), but that depends on whether this can be briefly explained without overburdening the article (like the terms we discussed before).
  • The second and third paragraphs of the criteria section only seems to repeat information from the symptoms section. I was thinking that maybe they could be removed. I guess it depends on how readers use the article. If they read the article from top to bottom those paragraphs may seem repetitive, but if they skip straight to this section because they're only interested in diagnosis repeating probably makes sense.
  • This is an artefact of WP:MEDMOS, resulting in repetition, which you rightfully note. But as you point out, some may go to specific sections only and only want that information. You rightfully point out repetition that has bothered me from the get-go, but there is a strong push in medical editing to conform strictly to MEDMOS. SandyGeorgia (Talk) 17:43, 23 May 2020 (UTC)[reply]
  • I was surprised by "Laboratory testing can rule out conditions such as depression". I would've expected that depression would be diagnosed by psychological exams rather than lab tests. Neither of the two sources for that sentence seems to mention lab tests for depression, but I might be overlooking something.
  • "East Asia and Japan" struck me as a little strange, since Japan is part of East Asia.
  • "Only palliative care can be offered, as there are no medications that can slow, stop, or improve the course of the disease. No medications for DLB are approved by the United States Food and Drug Administration as of 2019, although donepezil is licensed in Japan and the Philippines for the treatment of DLB" Is there a contradiction between those two sentences? Is donepezil just ineffective at treating with DLB? The article also mentions that donepezil is used in the UK. Wouldn't it makes sense to mention that here? Also, the article then mentions several medications that alleviate certain symptoms of LBD. Wouldn't that qualify as improving the course of the disease?
  • I think the confusion here is with the terms. "Slow, stop, or improve the course of the disease" means that, even if medications ameliorate the symptoms, the course of the disease is relentless progression towards death. That is what can't be improved. Does this help explain it better?
    Also, donepezil and many medications are used throughout the world, but off-label; they are licensed "for the purpose" of treating cognitive symptoms of DLB in Japan and the Phillipines, but nowhere else, even though they are used off-label universally. SandyGeorgia (Talk) 17:32, 23 May 2020 (UTC)[reply]
  • I have to say that I was a little underwhelmed by the Society and Culture section. It seems that it can be boiled down to two famous people possibly having had the disease. My thinking is that it could probably be condensed and incorporated into the history section, but I understand if you feel differently.
  • That is pretty much it, but the connection to Robin Williams is significant. The section names is one of those WP:MEDMOS things that I should probably not try to change, considering the environment in medical editing; I have found the MEDMOS sections to be particularly unsuited to the narrative in this article, but trying to change the sections would not likely end well. SandyGeorgia (Talk) 17:36, 23 May 2020 (UTC)[reply]

That's all I have. Overall, I think the article does a great job of explaining a difficult topic to people who might not be familiar with the field. I can't really comment on other aspects like accuracy, due weight, etc.--Carabinieri (talk) 12:30, 23 May 2020 (UTC)[reply]

Added this for biomarkers. SandyGeorgia (Talk) 20:52, 23 May 2020 (UTC)[reply]
Added this on heritability. SandyGeorgia (Talk) 20:54, 23 May 2020 (UTC)[reply]
Beefed up parkinsonism with this addition. SandyGeorgia (Talk) 21:09, 23 May 2020 (UTC)[reply]
Added a basic definition of executive function with this addition. SandyGeorgia (Talk) 21:24, 23 May 2020 (UTC)[reply]

@Carabinieri:, I think I've gotten everything now; here is a cumulative diff[25] of all of the changes per your suggestions (also specified individually above). Thank you so much for this detailed review, which must have taken you considerable time-- most appreciated! SandyGeorgia (Talk) 21:28, 23 May 2020 (UTC)[reply]

Happy to. I enjoyed contributing to something that's a little outside my usual comfort zone. Your explanations and changes cleared up all the issues I noticed in the article (I did change one additional instance of "East Asia and Japan", I hope that works). Thanks for the extra work you put into inserting those additional explanations. I'm happy to support this FAC (with the caveat that I've only reviewed the accessibility of the article and to some extent the prose; I can't comment on accuracy, due weight, comprehensiveness, or other questions).--Carabinieri (talk) 20:28, 24 May 2020 (UTC)[reply]

Guerillero

[edit]

Staking out a section for myself --Guerillero | Parlez Moi 14:07, 27 May 2020 (UTC)[reply]

The article is a dream to read. The prose could easily feel ripped out of a textbook. These are just thoughts and comments.

Sourcing thoughts

  • I'm not used to vancover citations, but they
  • Sometimes papers are in the works cited and sometimes they are in the footnotes. Why aren't all of the papers in the works cited?
  • Lewy Body Dementia Association's briefs looks like tertiary sources to me
  • "LBDA Clarifies Autopsy Report on Comedian, Robin Williams" looks like a press release to me. I'm skeptical that it meets the high quality sources bar
  • Robbins 2016 feels like an overcite to me. The CNN article and Williams 2016 seem to do the job
  • "Nocturnal sleep disturbances" and "Excessive Daytime Sleepiness" combined on final publication shouldn't we be using the published version instead of the preprint?

Prose thoughts

  • I am used to iodine-123 or 123I but not 123iodine. Do the sources used the spelled out version with the superscript prefix?
  • The increased morbidity and mortality with antipsychotics is in Medication and Supportive features. This seems repetitive to me.
  • The falls paragraph in Caregiving feels choppy to me

Fantastic article. It was a joy to look over. Thank you for all of the hard work --Guerillero | Parlez Moi 15:12, 27 May 2020 (UTC)[reply]

@Guerillero: thank you ever so much for engaging, and for the kind words about the prose. I get no prose credit (as mine is dreadful), and anything that is well written is credited to mostly Outriggr's copyedit dedication, but also to Ceoil, Colin and Yomangani, whose dedication to repairing my prose is most appreciated.
I only cited the works that needed to have page number detail. The others are listed directly because either the entire work is cited, or the work is so short it didn't need page number citations. If I move all of those to Works cited, we would merely end up with the same thing listed twice, which would just chunk up the page. I've seen other editors use this style, so hope it's OK.
On LBDA, yes, but notice the LBDA discussion of Robin Williams is only used to back up what other sources state (including Ian McKeith), so I feel like the LBDA is used appropriately for the content it is citing. My thinking on adding his wife's description is because of the confusing terminology throughout the Lewy Body dementias. We have the autopsy report using one term, the wife using another, and then Lewy body experts having to explain what each means. This is part of the problem with Lewy bodies, so I feel like it is worth going in to. It is also his wife's description that gives the facts needed for post-mortem diagnosis. That is, all of these different sources work together to explain what is tricky in any case, since DLB can't be diagnosed definitively when one is alive.
On the combined sleep issue, I did use the original publication, and cited to that. But when one looks at the courtesy copy online, it disagrees on that one section name, so I added an explanatory note. The alternative is to just leave off the courtesy link, which I don't think helps our readers.
On prose: yes, they do almost all use the preceding subscript 123.
Right you are on the duplication of info re antipsychotics: I have left a bit in Supportive features that explains why it's a supportive feature, eliminated some of the text and merged some of it to the Medication section.[26]
I merged the choppy falls paragraph with another, where it fits just as well. Thanks so much for the review; let me know please if these solutions do not satisfy. Best, SandyGeorgia (Talk) 18:46, 27 May 2020 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
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