lewy body

Question 1

cause of LBD?

Answer 1

accumulation of lewy bodies in basal ganglia

Question 2

core features and suggestive features and indicative biomarkers?

Answer 2

core:
1. wax and wane of cognition esp attention and alertness
2. visual hallucinations esp vivid, colorful, well formed small objects
3. REM sleep behavior disorder (acting out dreams esp fighting)
4. developing extrapyramidal signs at least one year after cognitive decline is evident

suggestive:
1. pronounced sensitivity to antipsychotics
2. autonomic instability
3. olfactory agnosia
4. postural instability and recurrent falls

biomarkers:
1. REM sleep behavior disorder on polysomnography
2. low 123iodine MIBG uptake on myocardial scintigraphy
3. low dopamine receptor uptake in basal ganglia by PET or SPECT

Question 3

dx?

Answer 3

definitive is by autopsy
possible LBD: one core without biomarker. or one or more biomarker without core.

probable: one core and one biomarker or two core

Question 4

tx?

Answer 4

cholinesterase inhibitors for cognitive and behavioral symptoms
quetiapine or clozapine for psychotic symptoms
melatonin and/ clonazepam for REM sleep behavior disorder

levodopa-carbidopa for parkinsonism is not effective here as it is in idiopathic parkinsonism and may worsen REM sleep disorder