First described in 1961 dementia wi...

First described in 1961 dementia with Lewy bodies is believed to account for up to 20 percent of dementia cases. The condition is characterized by dint of a progressive decline in cognitive function associated with fluctuation in cognition with pronounced variations in alertness, visual hallucinations, and/or motor parkinsonism (see Table 1) A review by the agency of Frank stresses the need for family physicians to recognize dementia with Lewy bodies and to provide specific treatment and management plans for this compage condition.

Dementia with Lewy bodies is slightly more everyday in men, and the mean age of first brunt is between 75 and 80 years. The cognitive changes in this dementia differ from those in Alzheimer's disease. Early in dementia with Lewy bodies, memory los is not prominent, however poor subscores on the Mini-Mental State Examination in the areas of attention, construction, and clock-drawing (visuospatial and executive functions) are typical. The early clinical picture may be complicated by dint of comorbid depression, apathy, anxiety, and anhedonia.

Fluctuations in cognitive abilities are characteristic of dementia with Lewy bodies. Patients may perform well in novel and stimulating situations but have episodes of "blankness" in which awareness of surroundings is decreased. The fluctuations make it difficult for caretakers and physicians to assess the of the same height of cognitive impairment. Assessment can be facilitated according to the Clinical Assessment of Fluctuation or the single in kind Day Fluctuation Assessment Scale.

A major clinical distinction between dementia with Lewy bodies and Alzheimer's disease is the adventure of visual hallucinations. The hallucinations usually are well formed and detailed (often of nation or animals coming into the patient's room) on the other hand auditory, olfactory, and tactile hallucinations also can come into one's head Treatment of the hallucinations may not be warranted, because risk for serious adverse reactions to neuroleptic physics reportedly is increased in patients who have dementia with Lewy bodies.

Motor parkinsonism is another core feature of dementia with Lewy bodies. Patients mind to have prominent rigidity, bradykinesia, masklike faces, and gait difficulties, if it were not that resting tremor is less frequent than in patients with classic Parkinson's disease. Symptoms of dementia serve to develop within a year of the attack of extrapyramidal signs. In contrast, delayed progress to maturity of dementia is more typical of parkinsonian dementia. Parkinsonian symptoms in dementia with Lewy bodies can be exacerbated rapidly by dint of neuroleptic drugs. Marked sensitivity to neuroleptic put drugs intos occurs in more than united half of patients, and the consequences can be irreversible. In these patients, neuroleptic physic use triples mortality, primarily secondary to harsh functional decline.

The diagnosis of dementia with Lewy bodies is based predominantly onward clinical features. Diagnosis can be difficult in patients with mild disease or coexisting Alzheimer's disease. The part of imaging studies is unclear.

the one and the other nonpharmacologic interventions and medications (see Table 2) are used to treat dementia with Lewy bodies. Patients, family members, and caretakers require considerable support and education, especially about the use of neuroleptic put drugs intos Because cholinergic deficit may be greater in patients with this condition than in those with Alzheimer's disease, cholinesterase inhibitors may play an important part in treatment. To date, studies of rivastigmine have reported improvements in apathy, anxiety, hallucinations, delusions, and cognition, on the other hand a high drop-out rate. Reported gains have been significant, with many patients improving from 30 percent or more, further benefits were lost on discontinuation of therapy.

Treatment of motor parkinsonism in dementia with Lewy bodies has not been studied extensively. Patients appear to correspond to standard levodopa-carbidopa combinations without a significant increase in side issues especially hallucinations.

Management of the psychotic features of dementia with Lewy bodies is complicated from the enhanced sensitivity to neuroleptic agents. Benefits and adverse validitys have been reported for risperidone therapy; small studies and case reports have noted benefit from other agents similar as olanzapine. Cholinesterase inhibitors should be tried first, and neuroleptic remedys should be reserved for situations where psychotic symptoms are causing serious distress, putting the patient or others at risk, or impeding care.

Frank C Dementia with Lewy bodies. Review of diagnosis and pharmacologic management. Can Fam Physician October 2003;49:1304-11