Dementia With Lewy-bodies = Eosinophilic Inclusion Body’s = A Synuclein And Ubiquitin Aggregates

Question 1

Parthophysiology

Answer 1

Cortical and subcortical deposition of Lewy-Bodies in the cortex (intracellular aggregates of ɑ-synuclein + ubiquitin aggregates)
- assosciated with Parkinson’s
If Parkinson’s before = Parkinson dementia
If L.B.D before = Lewy body dementia with Parkinsonism

Question 2

Clinical features

Answer 2

Cognitive symptoms precede motor symptoms unlike in Parkinson’s related dementia
Core symptoms:
- Fluctuating cognition = Memory and attention impairment
- Visual hallucinations and delusions
- Parkinsonian features
Suggestive symptoms:
- REM sleep disorder
- Sensitivity to antipsychotics

Question 3

Management

Answer 3

FIRST LINE = AChE (Acetylcholinesterase) inhibitor: donepezil or rivastigmine.
- Galantamine can be offered if the first two are not tolerated
Memantine: consider if AChE inhibitors are not tolerated or are contraindicated
Atypical antipsychotics: may be required in those with severe psychotic symptoms and must be used carefully due to the risk of worsening motor symptoms
Dopamine replacement: if there is evidence of parkinsonism

Question 4

Diagnosis

Answer 4

Diagnostic criteria include two of:
- Visual hallucinations
- Parkinsonism
- Fluctuating mental state