2007 issue 4

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Volume 16, issue 4

Review article

Dementia with Lewy bodies - clinical diagnostication

Stefan Krzymiński1, Grzegorz Rossa1, Sebastian Stoszek1
1. Wojewódzki Szpital Specjalistyczny dla Nerwowo i Psychicznie Chorych Samodzielnego Publicznego Zakładu Opieki Zdrowotnej w Ciborzu
Postępy Psychiatrii i Neurologii 2007; 16 (4): 315-324
Keywords: dementia with Lewy bodies, clinical picture, diagnosis

Abstract

Objectives. To review the literature on the clinical diagnostication of dementia with Lewy bodies (DLB).

Review. DLB is regarded as the second most frequent type ofprimary degenerative dementia, next to Alzheimer's disease (AD). In the clinical diagnostics of DLB particular attention is given to the specific neuropsychological profile of dementia, with a predomination of visuospatial and attention disorders over memory impairment in the early stage of the disease. As regards axial symptoms of DLB, considerable importance is ascribed to the fluctuation of cognitive processes and of the state of consciousness. Special scales for the evaluation of the latter have been developed. At present a major diagnostic significance is attributed to symptoms suggesting hypersensitivity to neuroleptics, REM sleep disorders, and a decreased nigrostriatal transport ofdopamine in functional neuroimaging. The presence ofoccipital hypoperfusion / hypometabolism in SPECT/PET investigations is also regarded as important for diagnosing DLB. This condition should be diagnosed, above all, for therapeutic reasons - in DLB there is an increased risk associated with the administration of neuroleptics. At the same time, DLB patients are respond better to the treatment with cholinesterase inhibitors.

Conclusion. The clinical picture ofDLB has no unique features. Similar symptoms are seen in Alzheimer's disease, Parkinson's disease with dementia, vascular dementia, and in other cerebral diseases. In each of these disorders a special caution is required concerning drug administration, in particular neuroleptics. Therefore, the clinical diagnostication of DLB is at present of theoretical rather than practical character.

Address for correspondence:
Dr Stefan Krzymiński
Cibórz 36/2, 66-213 Skąpe
e-mail: Stefan 4384392@pharmanet.com.pl