Lewy Body Dementias

Melissa J. Armstrong, MD, MSc, FAAN Dementia p. 128-146 February 2019, Vol.25, No.1 doi: 10.1212/CON.0000000000000685
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PURPOSE OF REVIEW: This article describes current diagnostic criteria relating to the diagnosis of Lewy body dementia, highlights diagnostic controversies, and reviews treatment approaches.

RECENT FINDINGS: Clinical diagnostic criteria for both Parkinson disease and dementia with Lewy bodies have been recently updated. These criteria result in overlap between individuals diagnosed with Parkinson disease and those with dementia with Lewy bodies. Although clinical features and symptomatic treatment overlap, differences remain in epidemiology and expected progression. The high prevalence of cognitive impairment in Parkinson disease supports regular screening for cognitive changes and counseling patients and families regarding what to expect. Treatment for Lewy body dementia involves avoiding medications that may cause or exacerbate symptoms; prescribing pharmacologic agents to address bothersome cognitive, behavioral, movement, and other nonmotor symptoms; recommending physical exercise and therapy; and providing education, counseling, caregiver support, and palliative care.

SUMMARY: Lewy body dementia includes both dementia with Lewy bodies and Parkinson disease dementia, overlapping clinicopathologic entities with differences relating to diagnosis and expected progression. Treatment is symptomatic and thus largely overlapping for the two conditions.

Address correspondence to Dr Melissa J. Armstrong, Department of Neurology, University of Florida College of Medicine, McKnight Brain Institute, L3-100 MBI, PO Box 100236, Gainesville, FL 32610, melissa.armstrong@neurology.ufl.edu.

RELATIONSHIP DISCLOSURE: Dr Armstrong serves on the evidence review board of Neurology journals and as a guideline consultant for the American Academy of Neurology and has received personal compensation for speaking engagements from the American Academy of Neurology and Medscape CME.Dr Armstrong receives research/grant support from the Agency for Healthcare Research and Quality (K08HS24159), 1Florida Alzheimer’s Disease Research Center (AG047266), and the Lewy Body Dementia Association Research Center of Excellence program and receives publishing royalties from Oxford University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Armstrong discusses the unlabeled/investigational use of biomarkers for the diagnosis of dementia with Lewy bodies and the unlabeled/investigational use of donepezil, galantamine, and memantine for cognitive symptoms in Lewy body dementia; clozapine and quetiapine for psychosis in Lewy body dementia; and clonazepam and melatonin for rapid eye movement sleep behavior disorder.

© 2019 American Academy of Neurology.