Specific focus on Dementia with Lewy Bodies Disease

03/12/2013 by admin | Psychiatry

Definition:

Epidemiology:  

Presenting symptoms / signs:  

  • Fluctuating cognition with great variations in attention and alertness from day to day and hour to hour
  • Recurrent visual hallucinations (observed in 75% of people with DLB)
  • Motor features of Parkinson’s. Suggestive symptoms are rapid eye movement, (REM)-sleep behavior disorder and abnormalities detected in PET or SPECT scans
  • Additional features may include = Parkinson’s features, tremors are less common in DLB than in Parkinson’s disease, problems with orthostasis, transient loss of consciousness, hypersensitivity to neuroleptic and antiemetic medications that affect dopaminergic and cholinergic systems.

 

Diagnostic investigations:

Aetiology:

  • Idiopathic
  • Possibly – PARK11 gene, APOE.

Pathophysiology:

DLB = the loss of cholinergic (acetylcholine-producing) neurons is thought to account for the degradation of cognitive functioning, as in Alzheimer’s disease; while the loss of dopaminergic (dopamine-producing) neurons is thought to account for the degradation of motor control, as in Parkinson’s disease

Treatment:

  • Treatment of the movement portion of the disease can worsen hallucinations and psychosis, while treatment of hallucinations and psychosis can worsen parkinsonian symptoms
  • Cholinesterase inhibitors, donepezil (Aricept), rivastigmine (Exelon) and galantamine – tx cognitive problems
  • Memantine, sinemet, clonazepam
  • Botulinum toxin injections in the parotid glands may help with sialorrhea. Other medications, such as methylphenidate and modafinil, may improve daytime alertness.
  • Palliative – no tx can stop disease progression.. thus caregiving is very important and incredibly demanding – always explore how the caregiver is feeling and coping with this task.

 

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