[Lewy body dementia and Parkinson disease dementia].
Lewy body dementia and Parkinson disease dementia are frequent causes of degenerative dementia: 20% of the dementias in patients older than 65 years are caused by the former and nearly 80% of patients with advanced Parkinson disease develop the latter. Symptoms of Lewy body dementia include fluctuations of cognitive performance, frontal and visuospatial impairment, visual hallucinations, and parkinsonism. Parkinson disease dementia could be differentiated in two subtypes: a "subcortical" subtype, characterized by frontal impairment with apathy and dullness and a "cortical" subtype with symptoms similar to those of Lewy body dementia. Mastery of potential iatrogenic factors is important: psychotropic drugs must be prescribed at the strict minimum, and L-dopa monotherapy at the minimal dose acceptable for correcting Parkinsonian motor symptoms should be the rule. Acetylcholinesterase inhibitors may be useful in both these types of dementia: rivastigmine is approved for treating Parkinson disease dementia and clozapine for reducing hallucinations.
Meyniel
Claire
C
CHU Nantes, Clinique neurologique, Nantes (44).
Damier
Philippe
P
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003937:Diagnosis, Differential; D018450:Disease Progression; D015259:Dopamine Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000175:diagnosis / Q000188:drug therapy; D018696:Neuroprotective Agents / Q000627:therapeutic use; D018697:Nootropic Agents / Q000627:therapeutic use; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D020734:Parkinsonian Disorders / Q000175:diagnosis / Q000188:drug therapy; D048448:Phenylcarbamates / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D000068836:Rivastigmine; D012702:Serotonin Antagonists / Q000627:therapeutic use
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D018696:Neuroprotective Agents; D018697:Nootropic Agents; D048448:Phenylcarbamates; D011619:Psychotropic Drugs; D012702:Serotonin Antagonists; D007980:Levodopa; D003024:Clozapine; D000068836:Rivastigmine