Dementia with Lewy bodies

Question 1

What features are characteristics of dementia with lewy bodies?

Answer 1

Visual hallucinations
Parkinsonian features
Daily fluctuations
Relatively early EPS features

Question 2

What cognitive deficits predominate in DLB?

Answer 2

Executive function

Visuospatial (clock face test)

Question 3

How can you differentiate DLB from AD?

Answer 3

Anterograde memory loss is less prominent in DLB so patients tend to do better in confrontation naming, short and medium term recall cf to AD

Visual hallucinations and daily fluctuations don’t occur as much in AD cf to DLB

Delusions, unexplained syncope, rapid eye movement sleep disorder, and neuroleptic sensitivity can all occurs in DLB where it doesn’t with AD

Question 4

Which Ix are indicated when ?DLB?

Answer 4

FBE, UEC
TFT
B12/Folate
Syphilus, HIV

MRI

CSF investigation is not routinely performed

Question 5

What is the role of imagining in the diagnosis of DLB?

Answer 5

Patients with vascular and DLB may have a similar presentation in which case MRI can be useful to look for white matter lesions that are characteristic in vascular dementia

Question 6

How is DLB treated?

Answer 6

Pharmacological
When hallucinations and agitation predominate then anti-cholinesterases are first line
- eg rivastigmine
Anti-psychotics (clozapine, aripiprazole, quetiapine) are second line

• Exercise and physical therapy to maintain mobility
• Maintain cognitive

Question 7

What is the prognosis of DLB?

Answer 7

Continued decline occurs

Patients develop immobility and dysphagia, which generally leads to increased falls risk, poor nutrition, and complications of being bed bound