Dementia Lewy Body

Question 1

Aetiology

Answer 1

Dementia with Lewy Bodies (10-15% of cases)

Cortical and subcortical Lewy bodies (abnormal deposits of protein inside nerve cells)

Lewy bodies: abnormally phosphorylated neurofilament proteins aggregated with ubiquitin and a-synuclein

In Parkinson’s, Lewy bodies are found in the brainstem but in DLB, they are seen in the cingulate gyrus and neocortex

May have features similar to Parkinson’s disease dementia.

By convention:

• Dementia with Lewy Bodies: develop cognitive symptoms and motor features of Parkinson’s disease within 1 year
• Parkinson’s disease dementia: develop dementia after > 12 months

Question 2

Symptoms

Answer 2

Think hallucinations and slow movements

• Repeated falls

Lewy Body Dementia includes:

• PD dementia = parkinsonism -> dementia
• DLB = dementia -> parkinsonism

Syncope or transient loss of consciousness

Fluctuating confusion with marked variation in levels of alertness

May resemble delirium

Severe sensitivity to antipsychotics (neuroleptic)- can result in death!

Delusions and hallucinations

Vivid visual hallucinations (Lilliputian hallucinations) – animals or humans

Parkinsonian motor features- shuffling gait, rigidity, slow movement (bradykinesia), loss of spontaneous movement

Autonomic dysfunction- postural hypotension, difficulty swallowing, incontinence or constipation

Sleep disturbance

Question 3

Management

Answer 3

Non-pharmacological interventions

Adaptations for the patient (with an occupational therapist)- reality orientation, environmental modifications

Social support/ carers

Optimising physical health (review medications)

Psychological therapies

Biological treatment

1st Line: AChEi

1st: Donepezil or Rivastigmine - can help with hallucinations

Galantamine if they are not tolerated

If AChEi are C/I- consider Memantine

Parkinson’s medications could relieve the tremors but they could worsen the psychosis and hallucinations so may consider withdrawing

Antipsychotics should NOT be used- can cause severe reactions, confusion, Parkinsonism, death - only consider if need to in cases without cog imp