Dementia With Lewy-bodies = Eosinophilic Inclusion Body’s = A Synuclein And Ubiquitin Aggregates

Question 1

Parthophysiology

Answer 1

Cortical and subcortical deposition of Lewy-Bodies in the cortex (intracellular aggregates of ɑ-synuclein + ubiquitin aggregates)
- assosciated with Parkinson’s
If Parkinson’s before = Parkinson dementia
If L.B.D before = Lewy body dementia with Parkinsonism

Question 2

Clinical features

Answer 2

• Cognitive symptoms precede motor symptoms unlike in Parkinson’s related dementia
• Visual hallucinations and delusions
• REM sleep disorder
• Memory and attention impairment
• Parkinsonism

Question 3

Management

Answer 3

FIRST LINE = AChE (Acetylcholinesterase) inhibitor: donepezil or rivastigmine.
- Galantamine can be offered if the first two are not tolerated
Memantine: consider if AChE inhibitors are not tolerated or are contraindicated
Atypical antipsychotics: may be required in those with severe psychotic symptoms and must be used carefully due to the risk of worsening motor symptoms
Dopamine replacement: if there is evidence of parkinsonism