Lewy Body Disease/Lewy Body Dementia

WHAT IS IT?

Lewy body disease/Lewy body dementia refers to a a progressive dementing illness that is associated with fluctuating cognitive impairment, visual hallucinations, and features of parkinsonism.

WHAT CAUSES IT?

This condition is thought to be caused by abnormal alpha-synuclein metabolism.

WHY IS IT A PROBLEM?

This condition will lead to cognitive impairment that is irreversible (as well as the other neurological changes outlined below)

WHAT MAKES US SUSPECT IT?

Risk factors

Early onset dementia

Initial Presentation

Common Chief Complaints:

• Cognitive impairment: such as memory issues, changes in alertness
• Visual hallucinations are present in most cases

Associated Symptoms:

• Parkinsonian features 
• Delusions 
• EPS symptoms

Physical Exam Findings

Mental status exam can demonstrate:

• Impaired alertness
• Visuospatial perception impairment

Visually clinician may appreciate:

• Myoclonus

HOW DO WE CONFIRM A DIAGNOSIS?

Histology will ultimately most definitely diagnosis this condition. It will reveal the presence of cortical Lewy bodies.

HOW DO WE RULE OTHER DIAGNOSES OUT?

**It can be hard to distinguish Lewy body dementia from a Parkinson patient who later develops dementia**

Visual hallucinations seen to be fairly specific to Lewy body dementia.

HOW DO WE TREAT IT? 

**Treatment of parkinsonian syndromes may worsen the neuropsychiatric symptoms, and vice versa**

• Antidopaminergic drugs (i.e. typical antipsychotics) will greatly exacerbate EPS symptoms in patients with this condition.

Atypical antipsychotics such as risperiodone and clozapine have been used to treat behavioral symptoms

HOW WELL DO THE PATIENTS DO?

This is an irreversible cause of dementia

WAS THERE A WAY TO PREVENT IT? 

N/A

WHAT ELSE ARE WE WORRIED ABOUT?

Usage of typical antipsychotics which are contraindicated in these patients (and will very likely cause EPS symptoms).

OTHER HY FACTS?

FURTHER READING

DynaMed

UpToDate

Page Updated: 07.15.2016