Dementia with Lewy bodies

Dementia with Lewy bodies

Pathology:               Neurodegenerative disorder characterized by Parkinsonism, visual hallucinations and dementia

Lewy bodies (inclusion bodies containing alpha-synuclein and ubiquitin)

Time of onset of cognitive symptoms concurrently or within 1 year of Parkinsonism.


Aetiology:                Most cases are sporadic affecting patients between 50 and 85 years.


Symptoms:               Cognitive Symptoms: Impaired memory, apathy, executive dysfunction and

visuospatial abilities.

Psychiatric Symptoms: Delusions, visual hallucinations and emotional lability.

Autonomic symptoms: Dry skin, orthostatic hypotension and sexual dysfunction

Other: Frequent falls, transient episodes of depressed consciousness


Signs:                         Parkinsonian features of rigidity and bradykinesia but fewer resting tremors.


Investigations:      Imaging: MRI/CT brain to exclude other causes of dementia

  DaT Scan: Reduced uptake of radioactive isotope in the basal ganglia


Treatment:              Dopaminergic Therapy: Levodopa for Parkinsonism but response is usually poor

Cholinesterase Inhibitors: Donepezil for cognitive symptoms

Atypical Antipsychotics: Quetiapine for psychiatric symptoms and hallucinations

                                                                                         Avoid neuroleptic drugs such as haloperidol


Complications:      Infection, incontinence, falls, self-neglect


Prognosis:               Mean survival 8 years from onset.

No disease modifying treatment is currently available.

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