Dementia with Lewy Bodies: Clinical Review

摘要

The aim of this article is to review the diagnosis and management of Dementia with Lewy Bodies. Dementia with Lewy bodies (DLB) is considered the second most common cause of dementia in the elderly after Alzheimer's disease. Diagnostic criteria for DLB is categorised into central feature ( progressive dementia), core features( fluctuating cognition, recurrent visual hallucinations and parkinsonism), suggestive features( rapid eye movement sleep behaviour disorder, increased sensitivity to neuroleptics and low dopamine transporter uptake in the brain's basal ganglia) and supportive features(repeated falls , transient loss of consciousness, hallucinations in other modalities, visuospacial abnormalities and autonomic dysfunction). DLB patients have the diffuse presence of Lewy Bodies in both sub cortical and cortical areas of the brain. Patients with DLB also have more severe dopamine and acetylcholine loss as compared to Alzheimer’s disease. Cholinesterase inhibitors can be used for the treatment of neuropsychiatric symptoms. Treatment with levodopa-carbidopa combinations should be considered when parkinsonian symptoms cause functional impairment. Antipsychotics should be used with great caution due to increased extra pyramidal adverse reactions. Clonazepam can be helpful to manage REM sleep behaviour disorder. Clinicians need to be aware of the diagnosis of DLB in order to provide appropriate pharmacological and nonpharmacological treatment for its cognitive, neuropsychiatric, motor and sleep disturbances without causing distressing side effects due to inappropriate drug prescription.