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Does this picture fit the pattern of dementia with Lewy bodies?
More, if you want it
When did the patient's thinking problems start?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: a dementia with fluctuating cognition, visual hallucinations, REM sleep behaviour disorder and spontaneous parkinsonism.
You can: Tell dementia with Lewy bodies from Parkinson's disease dementia by dementia starting first or within 12 months of parkinsonism.
Definition: findings such as falls and syncope that add weight to the diagnosis.
You can: Tell supportive features from core features by whether they define the disease.
Definition: marked rigidity or akinesia after a low antipsychotic dose.
You can: Name neuroleptic sensitivity when a low antipsychotic dose causes marked rigidity or akinesia.
Definition: dementia that develops more than 12 months after parkinsonism is established.
You can: Tell Parkinson's disease dementia from dementia with Lewy bodies by parkinsonism established more than 12 months before dementia.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
Fluctuating cognition, visual hallucinations, REM sleep behaviour disorder and parkinsonism are the core clinical features.
, , and parkinsonism are the core clinical features. Fluctuating cognition brings variable attention and alertness that change over time. A second core feature is recurrent, well-formed visual hallucinations. REM sleep behaviour disorder makes the patient move and act during dream sleep. Spontaneous parkinsonism brings rigidity, gait problems or unexplained falls.
The fluctuation looks like recurrent delirium-like phases, with function changing over time. Early on, memory may be less affected than attention, frontosubcortical skills and visuospatial ability. Normal-looking recall does not exclude the diagnosis. Parkinsonian motor features are not always apparent. The hallucinations recur, so asking the patient about them directly finds them. Misidentification can appear beside the visual hallucinations. The Maudsley guide names a triad: dementia with fluctuating cognition, early and persistent visual hallucinations, and spontaneous parkinsonism. Candidates read visions as a psychotic illness, or call the picture Alzheimer's disease.
Alistair attends a memory clinic in Newcastle. His wife says his thinking is clear one day and muddled the next. Alistair says, "Children keep playing in our front room."
Fluctuating alertness and parkinsonism often sit beside the visions in . Fluctuating alertness with well-formed visions and parkinsonism points to dementia with Lewy bodies.
Mnemonic
Lewy: mind leads or matches. Parkinson's: body leads by over a year. Cue: attention varies from hour to hour
In dementia with Lewy bodies the thinking problem comes first or within 12 months of the stiffness, so the mind leads or matches the body. In Parkinson's disease dementia the stiff, slow movement comes more than a year before the thinking problem, so the body leads.
5 more sections on Dementia with Lewy bodies, neuroleptic sensitivity and Parkinson's disease dementia
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