Dementia - Lewy Body

Question 1

What is the incidence of lewy-body dementia?

1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000

Answer 1

2 - 20 cases per 100,000

Effects men and women equally

Question 2

What age does the incidence of lewy body dementia typically peak?

1 - >70
2 - >60
3 - >50
4 - >40

Answer 2

1 - >70

Question 3

In lewy body dementia is their more short term memory loss or a progressive cognitive impairment?

Answer 3

1 - progressive cognitive impairment

Memory impairment is more Alzheimer’s

Question 4

In lewy body dementia does cognitive impairment continue to decline or can it fluctuate?

Answer 4

• fluctuate

Only form of dementia where cognition fluctuates

Question 5

Lewy body dementia and Parkinsons disease can occur together. Which one typically occurs 1st?

Answer 5

• Lewy body dementia

Question 6

Are visual hallucinations (other features such as delusions and non-visual hallucinations) common in patients with Lewy body dementia?

Answer 6

• yes

Lewy body = new hallucinations

Old depressed = old pets or spouses

Question 7

Which of the following are clinical features that patients with with Lewy body dementia present with?

1 - cognitive ability fluctuates
2 - some sparing of memory
3 - Parkinsonism
4 - visual hallucinations
5 - falls
6 - depression
7 - all of the above

Answer 7

7 - all of the above

Question 8

How can a-synuclein, a normal protein in the brain that is involved in synaptic vesicles trafficking and regulation of neurotransmitter release cause lewy bodies?

1 - clump together forming plaques that build up around synapses causing neuronal cell death
2 - mis-folded form of a-synuclein aggregate around synapse causing neuronal cell death
3 - excessive levels inhibit neurotransmitter release despite action potential
4 - binds to vesicles and inhibits vesicle binding to pre-synapse membrane

Answer 8

2 - mis-folded form of a-synuclein aggregate around synapse causing neuronal cell death

• the aggregates of misfolded protein are called Lewy bodies
• lewy bodies can cause neurons to die

Question 9

There are 2 types of dementia (that we need to know about) that are associated with lewy bodies (misfolded a-synuclien), what are these?

1 - Parkinsons disease dementia and dementia with lewy bodies
2 - Lewy body dementia and Alzheimers disease
3 - Alzheimers disease and Parkinsons disease
4 - Vascular dementia and Lewy body dementia

Answer 9

1 - Parkinsons disease dementia and dementia with lewy bodies

Question 10

Dementia with Lewy bodies and Parkinson’s disease dementia are both linked with abnormal folding of a-synuclein, which then aggregate and forms Lewy bodies. Where in the brain do these lewy bodies generally begin forming?

1 - motor cortex
2 - basal ganglia
3 - thalamus
4 - occipital lobe

Answer 10

2 - basal ganglia

• can also then move to the cortex, which then affects cognition

Question 11

When we investigate patients with dementia with Lewy bodies, it is very difficult to be able to determine where the build up of lewy bodies (aggregates of a-synuclein misfolded proteins) is in the brain and therefore make a diagnosis until post mortem. What else can be used to help diagnose?

Answer 11

• MRI/CT scans = may show atrophy or be normal
• Single-photon emission computed tomography may be able to identify where the lewy bodies are or the atrophy of the involved receptors are

Question 12

Single-photon emission computed tomography (SPECT) imaging using a ligand for dopamine transporter proteins can be used to detect atrophy of dopamine receptors. This can help identify if a patients symptoms are due to dementia with lewy bodies (cortical) or parkinsons dementia disease (sub-cortical), due to where is affected in the brain. In the image below, which is Alzheimers?

Answer 12

• 1
• can see atrophy in hippocampus
• large dark spaces in cortical area and ventricles
• uptake of ligand in caudate putamen (involved in motor control, cognition, and emotion)

Question 13

Single-photon emission computed tomography (SPECT) imaging using a ligand for dopamine transporter proteins can be used to detect atrophy of dopamine receptors. This can help identify if a patients symptoms are due to dementia with lewy bodies (cortical) or parkinsons dementia disease (sub-cortical), due to where is affected in the brain. In the image below, which is dementia with Lewy bodies?

Answer 13

• 2
• some atrophy of cortical area
• no significant hippocampus atrophy
• poor uptake by the caudate putamen (motor control, cognition, and emotion)

Question 14

What is the life expectancy of a patient with Lewy body dementia?

1 - 4-10 years
2 - 5-15 years
3 - 10-20 years
4 - >20 years

Answer 14

1 - 4-10 years

Question 15

Which class of drugs is the 1st line treatment for patients with Lewy body dementia?

1 - acetylcholinesterases
2 - dopamine agonists
3 - Catechol-O-methyltransferase inhibitor (COMT) inhibitors
4 - NMDA receptor antagonist

Answer 15

1 - acetylcholinesterases
- donepezil and rivastigmine

4 - NMDA receptor antagonist
- Memantine

These are used in same way as they are for Alzheimers

Question 16

Patients with dementia with Lewy bodies are highly sensitive to which group of drugs?

1 - ACE inhibitors
2 - antipsychotics
3 - benzodiazepines
4 - neuroleptics

Answer 16

2 - antipsychotics
4 - neuroleptics

• can be hypersensitive to these medications
• AVOID AT ALL COSTS