434 Dementia with Lewy bodies Flashcards
Levy body disease can manifest as ____ and _____ diseases
PDD - Parkinson’s disease with Dementia
DLB - Dementia with Lewy Bodies
________ in LBD affects performance of ADLS beyond other PD symptoms
Cognitive decline in LBD affects performance of ADLS beyond other PD symptoms
Key neuropathologic features in LBD (2)
- Lewy body
- Lewy neurites
Intraneuronal cytoplasmic inclusions
Lewy body
Stains with PAS and ubiquitin
Lewy body
Why PDD and DLB are classified as SYNUCLEINOPATHIES
Due to the presence of alpha-synuclein aggregates in neurons and glia of PDD and DLB
Best predicts the clinical benefits and NOT the Lewy pathology per se (2)
Neuronal and Synaptic loss
3 Stages of Progression in DLB
- Brainstem predominant
- Transitional limbic
- Diffuse neocortical
Usual start of PD (location)
Enteric nervous system
involved areas of the brain in Cholinergic vs Adrenergic deficit of DLB
Mutations of ________particularly lead to DLB or PDD presentations
Mutations of **GBA (glucocerebrosidase) **particularly lead to DLB or PDD presentations
7 biomarkers that can help distinguish LBD from AD
differentiate LBD from AD based on polysomnogram
differentiate LBD from AD based on CSF
differentiate LBD from AD based on MRI
differentiate LBD from AD based on PET SCAN (18F-deoxyglucose)
differentiate LBD from AD based on AMYLOID PET scan
differentiate LBD from AD based on MIBG myocardial scintigraphy
differentiate LBD from AD based on DAT scan or PET dopamine scan
4 meds for symptomatic treatment of LBD
Example of cholinesterase inhibitors as tx for LBD (2)
Example of atypical antipsychotics that can be given for symptomtic tx of LBD
Selective inverse agonist of serotonin 5-HT2a receptor that can be used for symptomatic tx of LBD
Known side effect of Pimavenserin
Known adverse effect of Clozapine
Why are DLB patients should not be exposed to Neuroleptics
Why are DLB patients should not be exposed to anticholinergics or dopamine agonists
Treatment for RBD
Alternative agents for tx of RBD if unresponsive to first line drug (3)
Treatment for mood and anxiety symptoms in LBD
Non pharmacologic tx for orthostatic hypotension in LBD (3)
Pharmacologic tx for orthostatic hypotension in LBD (3)
Differentiate DLB from AD based on MCI
Differentiate DLB from AD based on frequency and severity of fluctuating cognition with variations in attention
Differentiate DLB from AD based on SLEEP
Differentiate DLB from AD based on frequency recurrent visual hallucinations
Main diagnostic features of DLB (5)
Dementia and neuropsychiatric symptoms precede or co-emerge with the parkinsonism… PDD or DLB?
DLB
Presents in px with long -standing PD , who manifest dementia often with visual hallucinations, fluctuating attention or alertness, and RBD…… PDD or DLB?
PDD
More frequently has AD co-pathology ….. PDD or DLB?
DLB
Episodic memory disturbance points to the diagnosis of comorbid AD …. True or false
True
common DDX for DLB
timing of occurence of autonomic disturbances in MSA… early or late?
San mas severe ang autonomic disturbances…. DLB or MSA
San mas common ang ANOSMIA… LBD or MSA
difference between PD-MCI and MCI-DLB in terms of cognitive impairment
