lewy body

Question 1

pathological feature of lewy body dementia

Answer 1

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.

Question 2

features of lewy body dementia

Answer 2

1) progressive cognitive impairment
- in contrast to Alzheimer’s, early impairments in attention and executive function rather than just memory loss
- cognition may be fluctuating, in contrast to other forms of dementia
- usually develops before
parkinsonism

2) parkinsonism
3) visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Question 3

diagnosis of lewy body dementia

Answer 3

usually clinical
single-photon emission computed tomography (SPECT) is increasingly used. It is currently commercially known as a DaTscan.

Question 4

Mx of lewy body dementia

Answer 4

offer Rivastigmine or Donepezil FIRST LINE for cognitive impairment and behavioural symptoms

consider galantamine if above not tolerated

consider memantine if AChE inhibitors are not tolerated

carbidopa/levodopa used to treat motor symptoms

clonazepam - treat REM sleep behaviour disturbances - 30 minutes before sleep

sertraline SSRI - treat depression as it has fewer side effects

Question 5

what are the adverse reactions of antispsychotics in lewy body dementia

Answer 5

rigidity, immobility, postural falls, and confusion. They may lead to irreversible parkinsonism, particularly risperidone and typical antipsychotics such as Haloperidol