3c. Dementia with Lewy Bodies (cortical dementia)

Question 1

What is the overlap of DLB with AD pathology?

Answer 1

Amyloid plaques

Question 2

What is the overlap of DLB with PD pathology?

Explanation & how to differentiate?

Answer 2

(Brainstem) Lewy Bodies.

Explanation: sometimes it’s called the cortical variant of PD with dementia. Like in PD, there is a change in the neurons that are important for the dopamine production.

Differentiate: in PD the motor problems start many years before the cognitive problems, in LBD within the same year (1 year rule).

Question 3

DLB criteria: dementia and…

Name 4 core features (2: probable, 1: possible)

Answer 3

1. Fluctuating cognition
2. Recurrent visual hallucinations
3. Spontaneous features of parkinsonism (bradykinesia, tremor)
4. REM sleep behavior disorder (acting your dreams)

Question 4

DLB criteria: dementia and…

Name 7 supportive features

Answer 4

1. Severe sensitivity to antipsychotic agents
2. Repeated falls, postural instability, and syncope (=flauwvallen)
3. Transient, unexplained loss of consciousness
4. Severe autonomic dysfunction (constipation, urinary difficulties)
5. Hallucinations in other modalities (e.g. auditive)
6. Systematized delusions
7. Depression, apathy, anxiety

Question 5

What are 3 indicative biomarkers of DLB?

1. SPECT/PET
2. Heart
3. EEG

Answer 5

1. SPECT/PET: reduced dopamine transporter uptake in basal ganglia.
2. Heart: abnormal uptake in myocardial scintigraphy.
3. EEG: REM sleep disorder

Question 6

What are 3 supportive biomarkers of DLB?

1. MRI
2. SPECT
3. EEG

Answer 6

1. MRI: no tissue loss in medial temporal lobe, but atrophy in putamen.
2. SPECT: often hypoperfusion in the parieto-occipital lobe.
3. EEG: slow waves with periodic fluctuations.

Question 7

What 4 domains are mostly impaired in DLB?

Answer 7

1. Visuoconstruction problems
2. Attention problems
3. EF problems: mental inflexibility
4. Memory problems (later stages)