79 - Dementia with Lewy Bodies

Abstract

This chapter focuses on the diagnosis and management of dementia with Lewy bodies (DLB). DLB represents a still somewhat controversial entity defined by coexistent parkinsonism and progressive cognitive decline accompanied by spontaneous recurrent visual hallucinations and conspicuous fluctuations in alertness and cognitive performance. Current consensus restricts the diagnosis of DLB only to patients with parkinsonism who experience development of dementia within 12 months of the onset of motor symptoms. Patients with Parkinson's disease (PD) who experience development of dementia after 12 months of motor onset should be labeled PD dementia (PDD). To improve the differential diagnosis of DLB, consensus criteria have been developed that establish possible and probable levels of diagnostic accuracy. Management of patients with DLB has to be based on a multidimensional approach taking into account the cognitive decline and dementia that form the core clinical syndrome and the characteristic hallucinations and visual delusions present in a majority of cases, as well as dementia-associated behavioral symptoms and depression.