Lewy body dementia and Parkinson's disease with dementia.
Parkinson's disease (PD) is characterized by its motor impairment. However, non-motor symptoms such as psychiatric disorders, autonomic disturbances and sleep disorders frequently complicate the course of the disease. In particular, psychiatric disturbances including cognitive impairment, depression and psychosis impact these patients considerably. Approximately 31 % of PD patients suffer from cognitive impairment and dementia. Currently, two different clinical presentations are distinguished in PD patients, who present with dementia: Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB), which are two different presentations of a single underlying disease process leading to the deposition of alpha-synuclein. Clinically, PDD is distinguished from DLB alone by the different temporal manifestations of extrapyramidal motor symptoms. Dementia is characterized by a subtle onset and progressive cognitive decline with a predominant dysexecutive syndrome, which can be accompanied by different behavioral symptoms such as hallucinations, depression, anxiety and sleep disorders. Dysregulation of different neurotransmitters has been associated with cognitive decline, but reduced cholinergic transmission is currently thought to be the pivotal mechanism in the development of cognitive dysfunction. Therefore, cholinesterase inhibitors are used in the treatment of dementia and accompanying behavioral symptoms in PDD and DLB. The occurrence of dementia impacts not only the patients themselves but also their care-givers and family.This article focuses on the clinical issues related to both disorders and is based on a meeting of experts which took place in April 2008 in Dresden.
Dodel
Richard
R
Dept. of Neurology, Philipps-University Marburg, Marburg, Germany. dodel@med.uni-marburg.de
Csoti
Ilona
I
Ebersbach
Georg
G
Fuchs
Gerd
G
Hahne
Matthias
M
Kuhn
Wilfried
W
Oechsner
Matthias
M
Jost
Wolfgang
W
Reichmann
Heinz
H
Schulz
Jörg B
JB
D003072:Cognition Disorders / Q000209:etiology*; D003704:Dementia / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D020961:Lewy Body Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D009484:Neuropsychology; D010300:Parkinson Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D012890:Sleep / Q000502:physiology
J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):401-3
10084544
Neurology. 2007 Mar 13;68(11):812-9
17353469
Mov Disord. 2005 Sep;20(9):1161-9
15954137
Lancet Neurol. 2006 May;5(5):424-32
16632313
Mov Disord. 2005 Oct;20(10):1255-63
16041803
J Am Geriatr Soc. 2000 Aug;48(8):938-42
10968298
Ann Neurol. 2006 Apr;59(4):727
16566020
Methods. 2008 Apr;44(4):289-98
18374272
Age Ageing. 2005 Nov;34(6):561-6
16267179
Neurology. 2000 Nov 28;55(10):1575-7
11094120
Mov Disord. 2007 Sep;22 Suppl 17:S374-8
18175399
Mov Disord. 2007 Sep;22 Suppl 17:S358-66
18175397
Neurology. 2001 Mar 13;56(5):643-9
11245717
Lancet Neurol. 2004 Jan;3(1):19-28
14693108
Neurology. 2000 May 9;54(9):1774-9
10802783
Lancet. 2000 Dec 16;356(9247):2031-6
11145488
N Engl J Med. 2004 Dec 9;351(24):2509-18
15590953
J Neurol. 2008 Feb;255(2):255-64
18204803
J Neurol Neurosurg Psychiatry. 2002 Aug;73(2):134-40
12122169
Neurology. 1996 Mar;46(3):682-6
8618667
Neurology. 1998 Aug;51(2):351-7
9710002
Clin Neuropharmacol. 2004 Jul-Aug;27(4):153-6
15319699
BMJ. 1992 Sep 19;305(6855):673-8
1356550
Neurology. 1993 Nov;43(11):2227-9
8232934
Nervenarzt. 2007 Jun;78(6):715-27; quiz 728
17458526
Eur J Neurol. 2008 Apr;15 Suppl 1:21-5
18353133
Neurosignals. 2008;16(1):24-34
18097157
Curr Alzheimer Res. 2008 Feb;5(1):52-60
18288932
Cochrane Database Syst Rev. 2003;(3):CD003465
12917968
Parkinsonism Relat Disord. 2008;14(2):93-101
17707678
Neuroimage. 2008 Feb 1;39(3):1027-33
18035558
Neurology. 2004 Dec 14;63(11):2091-6
15596755
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004747
16437494
Neurology. 2005 Dec 27;65(12):1863-72
16237129
Pract Neurol. 2007 Nov;7(6):374-82
18024777
Arch Neurol. 2003 Mar;60(3):387-92
12633150
Mov Disord. 2007 Sep 15;22(12):1689-707; quiz 1837
17542011
Clin Chem Lab Med. 2006;44(2):192-5
16475906
Biochem Biophys Res Commun. 2006 Oct 13;349(1):162-6
16930553
Alzheimer Dis Assoc Disord. 2007 Apr-Jun;21(2):150-4
17545741