Lewy - Body Dementia

Question 1

What is Lewy-Body Dementia?

Answer 1

• Dementia with Lewy body is a common form of dementia characterised by finding Lewy bodies on pathology

Question 2

What is the difference between Parkinson’s disease dementia and Dementia with Lewy Body?

Answer 2

• Parkinson’s disease dementia: Dementia occurring in the setting of established Parkinson’s disease. Parkinson’s occurring for more than one year before the onset of dementia
• Dementia with Lewy Body: development of dementia and Parkinsonism concurrently. This is defined as developing dementia within one year of Parkinsonism features

Question 3

What is the Pathophysiology of Lewy-Body Dementia?

Answer 3

• Presence of Lewy bodies on histopathology
• Intracytoplasmic inclusions of alpha-synuclein that may be found throughout the brain and expressed in presynaptic membranes
• Dopaminergic neurones are more susceptible to dysfunction of alpha-synuclein

Question 4

What are some of the causes of Lewy- Body Dementia?

Answer 4

• Genetic and Acquired factors
• Genes: SNCA, PSEN1/PSEN2

Question 5

What are some of the Clinical Features of Lewy-Body Dementia?

Answer 5

• Fluctuating cognition, Visual Hallucinations, Parkinsonism and Sleep disorders

Question 6

What is the Management for Lew-Body Dementia?

Answer 6

• Cholinesterase inhibitors (rivastigmine, donepezil)
• Memantine
• Anti-psychotics (Quetiapine) - anti-dopamingergic effects these can worsen symptoms in patients
• Melatonin (refractory REM sleep disorders)
• Levodopa ( antiparkinson medication that may be used for severe disabling Parkinsonism features)