Lewy Body Dementia

Question 1

Px

Answer 1

Dementia- relative STM sparing.
Prog cog decline interf with soc and occup func, us incl deficit in atten, fronto subcortic skills, visuospat abil, later mem impair.
-3 core: 2 needs to be present.
Parkinsonism
Fluc cog performance/mem and conciousness/alertness over variable periods.
Complex recurr vivid hallucinations- us visual people or anims.
-other:
Sig dep 40%
Recurr falls/syncope
Transient LOC
Systematised delusions
Other hallucinations
AnitP neuroleptic sensitivity- SGE only with caution, start v low dose.
REM sleep disorder (like parkinsons)- incompl paral.

Question 2

Pathology

Answer 2

-lewy bodies- same as parkinsons.
Intracystoplasmic neuronal inclusiobs of abn Plated neurofilam prots aggreg with ubiquitin and alpha synuclein. In brainstem nuc, paralimbic and neocortex. Neuronal loss in brainstem and basal forebrain projecs assoc with reduc ach transmiss in neocortex. Cerebral and substantia nigra.
-also lewy neurites, AD type plaques, vascular dis.

Question 3

Diffs

Answer 3

other dementia
Delerium
Parkinsons
CJD
Dep psychosis
Mania

Question 4

Investigation

Answer 4

CT and MRI- sparing of medial temporal. Deep white matter lesions. Periventricular lucencies.
SPECT- medial temporal BF preserved, putamen reduced.
ApoE genot
DAT scan struc changes to basal ganglia (comma to full stop app) indicates either parkinsons or LBD.

Question 5

Mx

Answer 5

• AntiP with GREAT CAUTION- sev sensitivity reacs 50% eg irrev parkinsonism, impair concious, NMS like.
• achEI NOT NICE recomm bu toften used.
• ?clonazepam for sleep disturb.
• anti parkinsons medication.