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most common neurodegenerative dementia, yet it remains under-recognised and misdiagnosed, which delays treatment, causes inaccurate prognosis and limits research opportunities. Imaging with 2-[\n                      <jats:sup>18<\/jats:sup>\n                      F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) is a supportive DLB biomarker. We evaluated a multivariate, quantifiable metabolic network biomarker, termed DLB-related pattern (DLBRP), for its further clinical translation across centres and disease stages.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed demographic, clinical and FDG PET imaging data of 1180 participants from 14 tertiary centres and two multicentre datasets. We included 379 DLB, 28 mild cognitive impairment-LB (MCI-LB), 195 dementia due to Alzheimer\u2019s disease (ADD), 172 MCI-AD without \u03b1-synuclein co-pathology (MCI-AD-S\u2013), and 73 MCI-AD with \u03b1-synuclein co-pathology (S+) patients, along with a comparative group of 333 normal controls (NCs). From the scans, we calculated the expression of DLBRP, AD-related pattern (ADRP) and Parkinson\u2019s disease-related pattern (PDRP) and compared them across groups. DLBRP scores were correlated with clinical measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across independent cohorts, DLBRP robustly distinguished DLB from NCs (sensitivity &gt;89%, specificity &gt;90%), and scores correlated with Unified Parkinson\u2019s Disease Rating Scale Part III and independently predicted Mini\u2013Mental State Examination. DLBRP was elevated already in MCI-LB. In a small longitudinal dataset, we observed steady increases in DLBRP expression with scores exceeding the diagnostic threshold prior to dementia onset. DLBRP and PDRP discriminated DLB from ADD (sensitivity, 74%\u201390%; specificity, 80%). In MCI-AD groups, ADRP was expressed, whereas DLBRP and PDRP were increased only in MCI-AD-S+, although comparatively less than in MCI-LB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates the value of DLBRP in diagnosing prodromal and manifest DLB and distinguishing them from their AD counterparts. While overlap between patterns may reflect actual co-pathology, this possibility cannot be accepted without thorough pathological confirmation. The current findings support the use of DLBRP in patient evaluation and in future trial design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2025-336935","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:20:32Z","timestamp":1764872432000},"page":"316-324","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Metabolic brain networks in dementia with Lewy bodies: from prodromal to manifest disease stages"],"prefix":"10.1136","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8595-7773","authenticated-orcid":false,"given":"Matej","family":"Perovnik","sequence":"first","affiliation":[{"name":"Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urban","family":"Simon\u010di\u010d","sequence":"additional","affiliation":[{"name":"Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Jam\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milica","family":"Gregori\u010d Kramberger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"},{"name":"Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0959-4776","authenticated-orcid":false,"given":"Joachim","family":"Brumberg","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Center-University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp Tobias","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Center-University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Perani","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia 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