Dementia with Lewy Bodies : A Case Report (original) (raw)
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Journal of Neurology, Neurosurgery & Psychiatry, 1997
Objectives-To compare, in a retrospective clinicopathological study, the presentation features of patients with dementia and cortical Lewy bodies (Lewy body dementia) with those of patients with Alzheimer's disease. Methods-From a population of 426 cases from the dementia brain bank, 39 cases of Lewy body dementia and 61 cases of Alzheimer's disease with presentation details were identified. Results-The Lewy body dementia group had significantly more frequent hallucinations (23% v 3%, P = 0.006) and signs of parkinsonism (41% v 5%, P < 0-0001) than the Alzheimer's disease group. The Lewy body dimentia group also had a greater proportion of men (62% v 34%, P = 0.013). Conclusion-Hallucinations and signs of parkinsonism help distinguish Lewy body dementia from Alzheimer's disease at presentation. These indicators may not be very sensitive, because they were reported for less than half of the patients with Lewy body dementia.
Psychiatric symptoms in dementia with Lewy Bodies: Diagnostic and management issues
2011
Dementia with lewy bodies is the second most common type of dementia, but may often be misdiagnosed in clinical situations. It commonly presents with visual hallucinations and fluctuating cognition on a background of parkinsonian features and progressive cognitive decline in an elderly patient. A variety of psychiatric symptoms may occur in the course of the illness and often, there is an extreme sensitivity to neuroleptic drugs. In view of several complex and challenging issues, we discuss a case of dementia with lewy bodies from a diagnostic and management perspective.
Probable Dementia with Lewy Body
Romanian Journal of Neurology, 2017
V.A. female, 67 years, old admitted in our clinic for neurological assessment because of a parkinsonian syndrome, in association with neurocognitive disorder established in a psychiatric service. Motor disturbances and cognitive disorders are frecquently associated in Dementia with Lewy body (DLB) and in Parkinson Disease (PD). Psychiatric symptoms are difficult to manage as antipsychotics have frequently motor side effects. Criteria for possible and probable diagnosis of DLB according McKeith criteria and Diagnostic and Statistical Manual of Mental Disorders (DSM 5) are discussed.
Dementia with Lewy bodies: findings from an international multicentre study
International Journal of Geriatric Psychiatry, 2000
Objectives[ To describe the baseline demographic\ neuropsychiatric and neurological data of a large selected clinical sample of patients with dementia with Lewy Bodies "DLB# from an international multicentre trial with rivastigmine[ To examine the usefulness of the Consensus Criteria for the diagnosis of DLB in di}erent countries[ Methods[ Seventeen centres from Spain\ the UK and Italy recruited patients diagnosed clinically as probable DLB according to recent Consensus Criteria "McKeith et al[\ 0885#[ A standard clinical protocol including inclu! sion:exclusion criteria\ collection of demographic and medical data\ cognitive "Mini Mental State Examination] MMSE#\ motor "Uni_ed Parkinson|s Disease Rating Scale] UPDRS# and neuropsychiatric "Neuropsychiatric Inven! tory] NPI# examinations\ was applied after obtaining informed consent[ Data were summarised and compared across countries with uni! and multivariate analyses[ Results[ One hundred and twenty patients were recruited] 45[6) males\ mean "SD# age 62[8 "5[3# years\ range 46Ð 76 years[ Sixty percent ful_lled all three core diagnostic features of DLB\ and 39) only two "{parkinsonism| 81[3)\ {cognitive~uctuations| 78[0)\ {visual hallucinations| 66[2)#[ {Systematised delusions| "35)# and {repeated falls| "31)# were the most frequent supportive diagnostic features[ There were no di}erences across countries in demo! graphic\ diagnostic or clinical features[ Patients showed a wide range of psychopathology which was weakly correlated with cognitive impairment[ Some mild extrapyramidal signs "EPS# were observed in most patients[ Conclusions[ The Consensus Criteria for DLB can be consistently applied across many di}erent sites for multicentre studies[ {Parkinsonism| and {cognitive~uctuations| as core features and {systematised delusions| and {repeated falls| as supportive features are the most frequent diagnostic clues[ Neuropsychiatric disturbances\ in particular apathy\ delusions\ hallucinations and anxiety\ and mild symmetric EPS are frequent in DLB and are only related weakly to cognitive impairment[
A prospective study of dementia with Lewy bodies
Age and Ageing, 1998
little is known about the longitudinal course of dementia with Lewy bodies (DLB) and how this differs from Alzheimer's disease (AD). Method: standardized baseline and annual assessments of cognitive and non-cognitive symptoms are reported in a cohort of 72 patients with DLB or AD. AD was diagnosed using the NLNCDS ADRDA criteria and DLB was diagnosed with the criteria of McKeith et al. Cognitive assessment was undertaken using the MMSE schedule and operationalized definitions were used to diagnose non-cognitive symptoms. Results: 42 patients with DLB and 30 patients with AD were assessed. Of the 19 on whom post mortem examinations have been performed, 18 (95%) have had the clinical diagnosis confirmed. DLB patients were significantly more likely to experience visual hallucinations, disturbances of consciousness and parkinsonism at both baseline and at annual assessments. Of DLB patients exposed to neuroleptics, 33% developed sensitivity reactions. The magnitude and pattern of cognitive decline was similar in both groups. Conclusion: the importance of the core features highlighted in the newly proposed consensus DLB criteria is supported. These features appear to be stable over time.
Advances in Psychiatric Treatment, 1998
Lewy body formation is central to the pathological phenotype of a spectrum of disorders. The most familiar of these is the extrapyramidal syndrome of idiopathic Lewy-body Parkinson's disease (PD). Studies of dementia in the elderly suggest that another manifestation of Lewy body pathology is equally or more common than Parkinson's disease. This syndrome of Dementia with Lewy bodies (DLB) has been given a number of diagnostic labels and is characterised by dementia, relatively mild parkinsonism, visual hallucinations, and fluctuations in conscious level. Although many of these features can arise in Parkinson's disease, the patients with DLB tend to have early neuropsychiatric features which predominate the clinical picture, and the diagnosis of the syndrome in practice is more concerned with the differential diagnosis of Alzheimer's disease (AD). Distinction from AD has clinical importance because of potentially differing therapeutic implications. Diagnostic guidelines for the clinical diagnosis and pathological evaluation of DLB are reviewed. Research into the disorder has centered around characterising the clinical, neuropsychological, pathological, neurochemical and genetic relationships with Alzheimer's disease on the one hand, and Parkinson's disease on the other. Many cases of DLB have prominent pathological features of AD and there are some shared genetic risk factors. Differences from the pathology of PD are predominantly quantitative rather than qualitative and evidence is discussed which suggests that DLB represents a clinicopathological syndrome within the spectrum of Lewy body disorders. The possibility that the syndrome represents a chance association of PD and AD is not supported by published studies.
Behavioural and Psychological symptoms in a case of Dementia with Lewy Bodies
2018
Behavioural and psychological symptoms of dementia (BPSD) are common in dementia. These symptoms differ with the type of dementia. Dementia with lewy bodies(DLB) is a subtype of dementia characterised by visual hallucinations and sleep disorders. There are many criteria for diagnosing DLB including the behavioural and psychological symptoms. But clinical application of such criteria remains limited. Untreated BPSD symptoms can cause significant distress to patient and caregiver. This case report highlights the importance of proper application of the latest criteria for DLB and also the importance of early and prudent management of BPSD symptoms in DLB.
Are we missing dementia with Lewy bodies?: a case report
Australasian Psychiatry, 2018
Objectives: We aim to explore the importance of early diagnosis of dementia with Lewy bodies in order to facilitate effective psychiatric management. We present a case where delayed diagnosis stemming from an atypical presentation illustrates the complex issues involved in identifying and treating this type of dementia. Conclusions: We discuss the difficulty of diagnosis of this disorder in the absence of obvious memory dysfunction or parkinsonian symptoms. We use the case to draw attention to the limited availability of certain investigations and treatment options in Australia.