BACKGROUND: Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are the two most common types of dementing neurodegenerative disease after Alzheimer's disease (AD). Both of these conditions are often diagnosed late or not at all. METHODS: Selective literature review. RESULTS: The severe cholinergic and dopaminergic deficits that are present in both DLB and PDD produce not only motor manifestations, but also cognitive deficits, mainly in the executive and visual-constructive areas, as well as psychotic manifestations such as visual hallucinations, delusions, and agitation. The intensity of these manifestations can fluctuate markedly over the course of the day, particularly in DLB. Useful tests for differential diagnosis include magnetic resonance imaging and electroencephalography; in case of clinical uncertainty, nuclear medical procedures and cerebrospinal fluid analysis can be helpful as well. Neuropathological studies have revealed progressive alpha-synuclein aggregation in affected areas of the brain. In DLB, beta-amyloid abnormalities are often seen as well. CONCLUSION: DLB should be included in the differential diagnosis of early dementia. If motor manifestations arise within one year (DLB), dopaminergic treatment should be initiated. On the other hand, patients with Parkinson's disease should undergo early screening for signs of dementia so that further diagnostic and therapeutic steps can be taken in timely fashion, as indicated. Cholinesterase inhibitors are useful for the treatment of cognitive deficits and experiential/behavioral disturbances in both DLB (off-label indication) and PDD (approved indication).
BACKGROUND:Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are the two most common types of dementing neurodegenerative disease after Alzheimer's disease (AD). Both of these conditions are often diagnosed late or not at all. METHODS: Selective literature review. RESULTS: The severe cholinergic and dopaminergic deficits that are present in both DLB and PDD produce not only motor manifestations, but also cognitive deficits, mainly in the executive and visual-constructive areas, as well as psychotic manifestations such as visual hallucinations, delusions, and agitation. The intensity of these manifestations can fluctuate markedly over the course of the day, particularly in DLB. Useful tests for differential diagnosis include magnetic resonance imaging and electroencephalography; in case of clinical uncertainty, nuclear medical procedures and cerebrospinal fluid analysis can be helpful as well. Neuropathological studies have revealed progressive alpha-synuclein aggregation in affected areas of the brain. In DLB, beta-amyloid abnormalities are often seen as well. CONCLUSION: DLB should be included in the differential diagnosis of early dementia. If motor manifestations arise within one year (DLB), dopaminergic treatment should be initiated. On the other hand, patients with Parkinson's disease should undergo early screening for signs of dementia so that further diagnostic and therapeutic steps can be taken in timely fashion, as indicated. Cholinesterase inhibitors are useful for the treatment of cognitive deficits and experiential/behavioral disturbances in both DLB (off-label indication) and PDD (approved indication).
Authors: Dag Aarsland; Robert Perry; Jan P Larsen; Ian G McKeith; John T O'Brien; Elaine K Perry; David Burn; Clive G Ballard Journal: J Clin Psychiatry Date: 2005-05 Impact factor: 4.384
Authors: B Ravina; M Putt; A Siderowf; J T Farrar; M Gillespie; A Crawley; H H Fernandez; M M Trieschmann; S Reichwein; T Simuni Journal: J Neurol Neurosurg Psychiatry Date: 2005-07 Impact factor: 10.154
Authors: I G McKeith; D Galasko; K Kosaka; E K Perry; D W Dickson; L A Hansen; D P Salmon; J Lowe; S S Mirra; E J Byrne; G Lennox; N P Quinn; J A Edwardson; P G Ince; C Bergeron; A Burns; B L Miller; S Lovestone; D Collerton; E N Jansen; C Ballard; R A de Vos; G K Wilcock; K A Jellinger; R H Perry Journal: Neurology Date: 1996-11 Impact factor: 9.910
Authors: Murat Emre; Dag Aarsland; Alberto Albanese; E Jane Byrne; Günther Deuschl; Peter P De Deyn; Franck Durif; Jaime Kulisevsky; Teus van Laar; Andrew Lees; Werner Poewe; Alain Robillard; Mario M Rosa; Erik Wolters; Peter Quarg; Sibel Tekin; Roger Lane Journal: N Engl J Med Date: 2004-12-09 Impact factor: 91.245
Authors: Brit Mollenhauer; Lukas Cepek; Mirko Bibl; Jens Wiltfang; Walter J Schulz-Schaeffer; Barbara Ciesielczyk; Manuela Neumann; Petra Steinacker; Hans A Kretzschmar; Sigrid Poser; Claudia Trenkwalder; Markus Otto Journal: Dement Geriatr Cogn Disord Date: 2005-01-05 Impact factor: 2.959