Neuro Disorders: Lewy Body Dementia

Introduction

Lewy Body Dementia, also called as DLB (Dementia of Lewy Body type) is a relatively common type of dementia in older individual. AD (Alzheimer's Dementia) is the commonest type then come the DLB and vascular dementias. These 3 are the commonest dementias in the adults.

What causes DLB?

It is a neurodegenerative disorder. The exact case of this dementia is not known. Pathology studies reveal accumulation of Lewy bodies within the neurons and this might contribute to the degeneration of the neurons.

Clinical Presentation

Patients are typically late middle or old aged. The following manifestations are usually seen;

• Dementia like picture
• Parkinsonian manifestations (muscle stiffness, slowness of movements, tremors etc)

• Hallucinations, especially visual type
• Fluctuating mental status & level of consciousness

Diagnosis

The diagnosis can be confirmed with neuropathology tests however it is not done on routine basis. A CT or MRI of the brain is obtained to rule out other causes for dementia like MSA (multiple System Atrophy), PSP (Progressive Supranuclear Palsy) etc. A SPECT or PET scan is a useful test for differentiating DLB from AD type of dementia although this is not yet done on routine basis.

Treatment

There is no cure possible for DLB at this moment so symptomatic & supportive therapy is the mainstay of the management. Cholinesterase inhibitors like donepezil, or NMDA antagonist like memantine type of drugs are more useful to AD rather than DLB.

Parkinsonian manifestations are treated with anti Parkinson’s medications like levodopa but the response is generally poor.

Antipsychotic agents can be used for the hallucinations however DLB patients are very sensitive to the usage of these drugs so very small doses are to be used and the dose is titrated carefully.

A neurologist is frequently involved in the care of patients with Lewy Body Dementia.



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