Prognosis and treatment of dementia with Lewy bodies
- Martin R Farlow, MD
Martin R Farlow, MD
- Professor of Neurology
- Indiana University School of Medicine
Dementia with Lewy bodies (DLB) is increasingly recognized clinically as the second most common type of degenerative dementia after Alzheimer disease (AD). In addition to dementia, distinctive clinical features include: visual hallucinations, parkinsonism, cognitive fluctuations, dysautonomia, sleep disorders, and neuroleptic sensitivity.
First described in the 1960s, DLB has a varied clinical presentation that shares features with other degenerative dementias. It was often overlooked pathologically because of the difficulty in identifying cortical Lewy bodies. With the advent of immunohistochemical stains for constituents of Lewy bodies, the prevalence of this disorder began to be recognized. However, challenges remain in defining this as a distinct entity from other degenerative dementias.
There is some clinical imperative to diagnose DLB, as optimal treatment choices – for best efficacy and limitation of significant side effects – are specific to DLB. However, DLB continues to be under recognized, and the clinical diagnostic criteria continue to be refined to improve specificity and sensitivity.
This article will describe the prognosis and treatment of dementia with Lewy bodies. The epidemiology, neuropathology, pathogenesis, clinical features, and diagnosis are discussed separately. (See "Epidemiology, pathology, and pathogenesis of dementia with Lewy bodies" and "Clinical features and diagnosis of dementia with Lewy bodies".)
The treatment of other dementia syndromes and the treatment of dementia in general are discussed separately. (See "Cholinesterase inhibitors in the treatment of dementia" and "Treatment of dementia" and "Management of neuropsychiatric symptoms of dementia" and "Cognitive impairment and dementia in Parkinson disease" and "Frontotemporal dementia: Treatment" and "Treatment and prevention of vascular dementia".)
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- General strategies
- Cognition and neuropsychiatric disturbances
- - Cholinesterase inhibitors
- - Memantine
- - Neuroleptics
- - Other psychotropic medications
- REM sleep behavior disorder
- Parkinsonian symptoms
- Orthostatic hypotension
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS