Dementia with Lewy bodies

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By Ann Marie Hake MD

Dementia with Lewy bodies is also known as or subsumes Cortical Lewy body disease, Diffuse Lewy body disease, DLB, DLBD, Lewy body dementia, Lewy body variant of Alzheimer disease, Senile dementia of Lewy body type, Synucleinopathy. -ed.

In this clinical article, Dr. Ann Marie Hake of the Indiana University School of Medicine reports on the entity known as dementia with Lewy bodies. She details the clinical features, pathogenesis and pathophysiology, and the sometimes difficult differential diagnosis, as well as common complications of the disease.

Key Points

  • Dementia with Lewy bodies is second only to Alzheimer disease as the most frequent cause of neurodegenerative dementia and accounts for approximately 20% of cases in the elderly.
  • Dementia with Lewy bodies is clinically characterized by any combination of cognitive impairment (especially deficits of attention, executive function, or visuospatial function), fluctuations of cognition, recurrent visual hallucinations, and spontaneous motor features of parkinsonism.
  • The diagnosis of dementia with Lewy bodies may be difficult, especially early in the course, as the clinical features are variable among individual patients.
  • Recognition of dementia with Lewy bodies is important, as patients are at increased risk of sensitivity to certain medications such as neuroleptics and anticholinergics, which can lead to increased morbidity and mortality in this population.
  • Individuals with dementia with Lewy bodies may respond very well to cholinesterase inhibitors, which are the current first-line therapy for this condition.