Dementia with Lewy Bodies

Question 1

LBD

Answer 1

• accounts for 15-20% dementia
• presents with progressive dementia and PD symptoms
• fluctuation in level of attention and severity of cognitive impairment seen

Question 2

Lewy bodies

Answer 2

• eosinophilic intracytoplasmic neuronal inclusion bodies
• made of abnormally phosphorylated neurofilament proteins
• aggregated with ubiquitin and alpha-synuclein

Question 3

Central feature of LBD

Answer 3

-progressive cognitiive decline of sufficient magnitude to interfere with normal social or occupational function

Question 4

Core features of LBD

Answer 4

• 2 of the floowing
• fluctuating cognition with profound variations in attention and alertness
• recurrent visual hallucinations
• spontaneous motor features of parkinsonism (seen in 70%)

Question 5

Supportive features of LBD

Answer 5

• repeated falls due to autonomic dysfunction
• syncope
• transient disturbances of consciousness
• neuroleptic sensitivity
• systematised delusions
• hallucinations in other modalities

Question 6

Paranoid delusions and auditory hallucinations

Answer 6

• 65% have paranoid delusions

- 20% have auditory hallucinations

Question 7

Visual hallucinations

Answer 7

• seen in 60-80% cases of LBD

- well formed and detailed

Question 8

Sensitivity to antipsychotics

Answer 8

• 60% of cases

- 50% individuals have very severe reactions

Question 9

Mean survival rate

Answer 9

• approx 8 years
• but can occur over 1-2 years
• 10% decline rate per year in terms of worsening parkinsonism

Question 10

APOE E4 allele

Answer 10

-also seen in LBD

Question 11

Scanning

Answer 11

• sparing of medial temporal lobes on CT/MRI scan is noted

- medial temporal lobes are preserved in SPECT

Question 12

Memory deficits

Answer 12

• short term memory is relatively spared

- attention and frontal subcortical skills and visuospatial ability may be significantly impaired

Question 13

Pathological features of LBD

Answer 13

• Lewy related neuritis
• plaques
• NF tangles
• regional neuronal loss in brainsteam (locus cereleus and SN)
• microvacuolation (spongiform change)
• synapse loss

Question 14

Drugs in LBD

Answer 14

• cholinesterase inhibitorys improve cognition, delusions, hallucinations in LBD
• Rivastigmine is thought to be good
• cholinesterase inhibitors are not licensed