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Dementia with Lewy bodies
From WikEM
Contents
Background
- Neurodegenerative disorder (dementia)
- More rapid progression than Alzheimer's or Parkinson's disease
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
- 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
Evaluation
- See Dementia Work-Up
Management
- Avoid neuroleptics and anticholinergics
- Supportive care, symptom management
