Semin Neurol 2019; 39(02): 274-282
DOI: 10.1055/s-0039-1678579
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Parkinson's Disease Dementia and Lewy Body Disease

Mine Sezgin
1  Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Basar Bilgic
1  Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Sule Tinaz
2  Divison of Movement Disorders, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
,
Murat Emre
1  Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Abstract

Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PD-D) are Lewy body-related neurodegenerative disorders sharing common clinical and neuropathological findings. The clinical features of both conditions include cognitive impairment, behavioral symptoms, autonomic dysfunction, sleep disorders, and parkinsonism. The cognitive profile of both disorders is characterized by particularly severe deficits in executive and visuospatial functions as well as attention. Clinical differentiation between DLB and PD-D is based on an arbitrary distinction between the time of onset of parkinsonism and cognitive symptoms; extrapyramidal symptoms precede dementia in PD-D, whereas it coincides with or follows dementia within 1 year in DLB. When the clinical picture is fully developed, DLB and PD-D are practically indistinguishable. Although the diagnosis is basically clinical, structural and functional neuroimaging as well as cerebrospinal fluid biomarkers may help the clinician in the diagnosis. Placebo-controlled randomized trials of the cholinesterase inhibitors have shown modest but significant benefits in cognition, global function, and neuropsychiatric symptoms in both disorders. Behavioral symptoms such as hallucinations and delusions should be treated with caution with antipsychotics, as they have the potential to worsen motor and cognitive symptoms.