Dementia with Lewy bodies

Question 1

Definition

Answer 1

1. a neurodegenerative disease involving lewy bodies which are protein deposits within neurons

Question 2

Pathophysiology

Answer 2

1. normally neurons contain a protein called Alpha - synuclein
2. in Lewy body dementia, this protein gets misfolded within the neuron
   3, misfolded proteins aggregate to form Lewy bodies within the neuron
3. as disease progresses, more and more neurons accumulate lewy bodies and die

Question 3

Early symptoms of dementia with lewy bodies (cognitive)

Answer 3

( similar to Alzheimer’s )

1. difficulty focussing
2. poor memory
3. visual hallucinations
4. disorganised speech

Question 4

Later symptoms ( motor )

Answer 4

( similar to parkinson’s disease but milder )

1. resting tremor
2. stiff and slow movements
3. reduced facial expressioms
4. shuffling gait
5. rigidity
6. Bradykinesia

Question 5

main features of lewy body dementia

Answer 5

1. progressive cognitive impairment
2. parkinsonism
3. visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Question 6

lewy body dementia + other diseases

Answer 6

The relationship between Parkinson’s disease and Lewy body dementia is complicated, particularly as dementia is often seen in Parkinson’s disease. Also, up to 40% of patients with Alzheimer’s have Lewy bodies

Question 7

diagnosis

Answer 7

1. based on pattern of clinical symptoms

2. DaT scan - 90% sensitivity

Question 8

Management

Answer 8

1. cognitive symptoms - acetylcholinesterase inhibitors
   - Donepezil
   - Rivastigmine
2. Motor symptoms - drugs used to treat parkinsonims
   - Levadopa