Question

Please tell me more about Lewy body dementia.

Answer

Lewy body dementia (DLB) is progressive, but progression is variable in different people. To make a diagnosis of DLB, a person must have dementia, but may have a less prominent memory impairment at onset than with Alzheimer's disease. Psychometric defects, inattention, fronto-subcortical skills and visuospatial abilities may be prominent. The core features, with two or more equalling a likely diagnosis of DLB, and one or more a possible diagnosis of DLB, are: Fluctuation of cognition, with pronounced variation - inattention and alertness and delirium should be excluded; hallucinations, recurring, visual, well-formed and detailed; spontaneous Parkinsonism. Supporting criteria are the occurrence of repeated falls, syncope, transient loss of consciousness, neuroleptic sensitivity, systematised delusions, and non-visual hallucinations. It is extremely difficult to make the diagnosis with certainty during life, and autopsy must be performed for a definitive diagnosis. Lewy bodies are found predominantly in subcortical regions in Parkinsonian patients without dementia. In demented Parkinsonian patients, Lewy bodies are present in the cortex.

The treatment may include L-dopa, as in Parkinson's disease, and perhaps the newer acetylcholinesterase inhibitors, as there are indications of acetylcholine deficiency in DLB.

Neuroleptic agents should be avoided if DLB is suspected.

Links

• Diagnosing Lewy body dementia