Dementia with Lewy bodies

Background

• Neurodegenerative disorder (dementia)
• More rapid progression than Alzheimer's or Parkinson's

Clinical Features

• fluctuating cognition
• recurrent visual hallucinations
• Parkinsonian motor symptoms (cogwheel rigidity, shuffling gait, retropulsion)
• REM-sleep disturbance
• Neuroleptic sensitivity, increased risk for neuroleptic malignant syndrome
  • Acute worsening of cognition or delirium, with antipsychotics, benzodiazepines, anticholinergics, surgical anesthetics

Differential Diagnosis

Dementia Acronym

D = drug-induced

E = emotions (depression especially)

M = metabolic and endocrine issues

E = eyes and ears (sensory problems)

N = nutritional issues (B12 and Vit. D)

T = tumors

I = infections

A = alcohol

S = sleep disorders and rarely seizures

Dementia

• Degenerative
  • Alzheimer's disease
  • Huntington's disease
  • Parkinson's disease
• Vascular
  • Multiple infarcts
  • Hypoperfusion (MI, profound hypotension)
  • Subdural hematoma
  • SAH
• Infectious
  • Meningitis (sequelae of bacterial, fungal, or tubercular)
  • Neurosyphilis
  • Viral encephalitis (HSV, HIV), Creutzfeldt-Jakob disease
• Inflammatory
  • SLE
  • Demyelinating disease (e.g. multiple sclerosis)
• Neoplastic
  • Primary brain tumor / metastatic disease
  • Carcinomatous meningitis
  • Paraneoplastic syndromes
• Traumatic
  • Traumatic brain injury
  • Subdural hematoma
• Toxic
  • ETOH
  • Meds (anticholinergics, polypharmacy)
• Metabolic
  • B12 deficiency or folate deficiency
  • Thyroid Disease
  • Uremia
• Psychiatric
  • Depression (pseudodementia)
• Hydrocephalic
  • Normal pressure hydrocephalus (communicating hydrocephalus)
  • Noncommunicating hydrocephalus

Management

• Avoid neuroleptics and anticholinergics
• Supportive care, symptom management