Now let's talk about
Lewy Body Dementia.
Lewy Body Dementia is a progressive
degenerative brain disorder
characterized by dementia,
and a Parkinsonism, often with
frequent neuroleptic sensitivity.
And it's in the differential
diagnosis for both a Parkinsonism
because patients present with prominent
Parkinsonism as well as dementia,
and it's in our dementia
differential as well.
It kind of lives in the middle of the
dementia and parkinsonism evaluations.
When we think about
Parkinsonism and dementia,
there are two ways in
which that can present.
We can see patients with
disease that develop dementia,
and that's called PD dementia.
We also see dementia in
dementia with Lewy bodies
and the timeline of onset, the sequence of
those findings are critically important.
With PD dementia,
patients develop early Parkinsonism
and late cognitive dysfunction.
And by rule the cognitive dysfunction
should develop at least 1 year
after the onset of Parkinsonism
in PD dementia patients.
dysfunction is late.
The Parkinsonism is early.
In dementia with Lewy
bodies the opposite is true.
Here, the pathology
begins in the cortex,
and then descends rapidly into the
subcortical basal ganglia structures.
We see early memory loss and by
rule that should be within 6 months
of the onset of Parkinsonism.
Now not every patient
reads the book.
It should be how the test
questions are written.
And in clinical practice,
we see some variability.
But in dementia with Lewy bodies,
we're looking for early onset memory loss
in relation to the Parkinsonism.
In terms of clinical
this is a Parkinsonism with
prominent dementia features.
We see dementia often with
and that's a hallmark of
dementia with Lewy bodies.
We can see fluctuating cognition
that can look like a delirium.
REM behavior disorder is not uncommon
and Parkinsonism is a hallmark.
In terms of the natural history,
the dementia occurs before, at,
or just at the beginning of the
onset of the Parkinsonian signs
and that time course is really important
to sort out in our history taking.
In terms of diagnosis,
this is also a clinical diagnosis.
And we're using that
combination of history,
and some of those wildcard features
to establish the diagnosis.
In terms of treatment, there is no disease
modifying therapy for Lewy body dementia.
We will often consider
a levadopa challenge
as we do for other
and typically that is incomplete or
no response to levadopa can be seen.
Cholinesterase inhibitors can be important
for supporting cognitive function.
can be used
but we must consider the possibility
of neuroleptic sensitivity.
And so we start with low doses,
and typically agents that
are less likely to offend
second or third line agents,
third generation agents.
And regular exercise is probably
the most helpful treatment
for any neurodegenerative
When we look at all the studies
that have been performed,
regular physical activity is it
promotes active mental health
and reduces neurodegenerative
dysfunction over time.