Geriatrics - Lewy Body Dementia

Question 1

Where do Lewy bodies accumulate in the brain?

Answer 1

Substantia nigra
Paralimbic
Neocortical areas

Question 2

What are the features of Lewy body dementia?

Answer 2

Progressive cognitive impairment
- Occurs before parkinsonism, usually both features within 1 year of each other vs Parkinson’s where motor symptoms present 1 year before cognitive
- Cognition may fluctuate
- Early impairments in attention and executive function rather than memory loss

Parkinsonism

Visual hallucinations
- Can also get delusions and non-visual hallucinations

Question 3

How is Lewy Body Dementia diagnosed?

Answer 3

Clinical diagnosis

Question 4

What imaging can be used in Lewy Body Dementia diagnosis?

Answer 4

Single-photon emission computed tomography (SPECT)

Also known as a DaTscan, radioactive dopamine isotope

90% sensitivity
100% specificity

Question 5

How is Lewy Body Dementia managed?

Answer 5

AChEis (donepezil, rivastigmine) + Memantine

Avoid neuroleptics patients are extremely sensitive and can develop irreversible parkinsonism

Similar to Alzheimer’s