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Updated: Nov 12 2021

Dementia With Lewy Bodies

  • Snapshot
    • A 67-year-old man is brought to the neurologist by his wife for bizarre behaviors. She said that at times he would be difficult to understand and disorganized. He also said that he has seen animals on top of the television which was disturbing for him. He would speak in his sleep. Physical examination is notable for postural instability and upper extremity rigidity.
  • Introduction
    • Definition
      • progressive dementia characterized by
        • fluctuating cognition
        • visual hallucinations
        • parkinsonism
        • REM sleep disorder
  • Epidemiology
    • Incidence
      • second most common type degenerative dementia
  • Etiology
    • Lewy bodies
    • Pathogenesis
      • accumulation of Lewy bodies and α-synuclein
  • Presentation
    • Symptoms/physical exam
      • cognitive dysfunction
        • early findings
          • impaired attention, executive, and visuospatial function
        • flucuating cognition
      • visual hallucinations
        • people, animals, shapes, or colors
      • REM sleep behavior disorders
        • dream enactment
      • parkinsonism
        • bradykinesia and akinesia
        • rigidity
        • gait disorder
        • resting tremor is rare
      • antipsychotic sensitivity
        • taking antipsychotics lead to severe parkinsonism and unresponsiveness
      • autonomic dysfunction
  • Studies
    • Making the diagnosis
      • this is a clinical diagnosis
    • Histology
      • eosinophilic intracytoplasmic inclusions (Lewy bodies)
        • also contain aggregated α-synuclein
  • Differential
    • Alzheimer disease
      • differentiating factors
        • memory loss is an early, prominent feature
  • Treatment
    • Medical
      • acetylcholinesterase inhibitors
        • indication
          • recommended for vascular dementia
      • medications
        • donepezil
        • galantamine
        • rivastigmine
  • Complications
    • Major depression
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