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.
Keywords
dementia with Lewy bodies - Parkinson's disease dementia - synucleinopathy - imaging
