Dementia with Lewy bodies

Clinical manifestations
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By Ann Marie Hake MD

Dementia with Lewy bodies is the second most common form of neurodegenerative dementia, accounting for up to 20% of cases in the elderly (Baskys 2004; Schneider et al 2012). It is characterized by fluctuating cognitive impairment, parkinsonism, and recurrent visual hallucinations. Consensus-based clinical criteria have been published and have been shown to have high specificity but still lack sensitivity (McKeith et al 2005) (see the criteria in the Diagnostic workup section). Patients can present with a wide range of signs and symptoms. Grouping the symptoms, as seen in Table 1, can facilitate the diagnosis.

Table 1. Clinical Features of Dementia with Lewy Bodies

Cognitive impairment

forgetfulness (retrieval more impaired than recognition memory)
apathy
psychomotor slowing
impairments of attention
visual-spatial impairments
subcortical dementia features
increased risk of delirium

Neuropsychiatric features

hallucinations
delusions
behavioral dysregulation
agitation
aggression
nocturnal wandering
disinhibition
depression
emotional lability
pseudobulbar affect
anxiety
obsessive/compulsive symptoms

Motor dysfunction

extrapyramidal features, typically symmetric akinetic-rigid form of parkinsonism with mild to moderate rigidity and bradykinesia
typically not a classic asymmetric resting tremor
mild symmetric postural and kinetic tremor is common

Sleep disorder

REM sleep behavior disorder
insomnia
restless legs syndrome
periodic limb movements of sleep
excessive daytime sleepiness

Autonomic Dysfunction

orthostatic hypotension
poorly regulated sweating
poorly regulated body temperature
dry skin
decreased ventilatory response to hypercapnia
incontinence
detrusor hyperactivity
erectile dysfunction
constipation
gastroparesis
cardiac arrhythmias

Adapted from: (Boeve 2004).

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Anesthesia
References cited
Contributors