[Dementia with Lewy bodies].
BACKGROUND
Some 10%-15% of patients with dementia are diagnosed as dementia with Lewy bodies (DLB), a disorder characterised by the presence of Lewy bodies in the brainstem and cortex.


METHODS
Review of pathology, clinical symptoms, pharmacological and nonpharmacological treatment, based on the literature and on personal experience.


RESULTS
Neurochemical findings are marked cortical reduction of acetylcholine and nigrostriatal dopamine deficiency. Key features of the clinical syndrome are dementia, fluctuating consciousness, visual hallucinations and parkinsonism. There are pathological and clinical overlaps between DLB and Alzheimer's disease on the one hand, and between DLB and Parkinson's disease on the other; the relationship between these diseases awaits further elucidation. Clinical consensus criteria for DLB have been published and shown to have high sensitivity and specificity. Fluctuating consciousness may be difficult to detect, but diagnostic instruments exist that may help in the evaluation. Drug treatment of DLB is difficult. Cholinesterase inhibitors have been shown to improve cognition and psychiatric symptoms. Atypical antipsychotics may improve psychosis, but some patients develop severe sensitivity reactions. The effect of antiparkinson agents is unknown.
Arsland
Dag
D
Alderspsykiatrisk seksjon Rogaland psykiatriske sjukehus Postboks 1163 Hillevåg 4095 Stavanger. daa@post.rps.no
D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D001921:Brain / Q000473:pathology; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage; D003937:Diagnosis, Differential; D006801:Humans; D016631:Lewy Bodies / Q000473:pathology; D020961:Lewy Body Disease / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D008609:Mental Status Schedule
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors