What are the signs and symptoms of dementia with Lewy bodies (DLB)?

Updated: Aug 08, 2019
  • Author: Howard A Crystal, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Symptoms and signs of DLB may result, in part, from disruption of bidirectional information flow from the striatum to the neocortex, especially the frontal lobe.

The following clinical features help to distinguish DLB from Alzheimer disease:

  • Fluctuations in cognitive function with varying levels of alertness and attention (eg, excessive daytime drowsiness despite adequate nighttime sleep or daytime sleep >2 hours, staring into space for long periods, episodes of disorganized speech)

  • Visual hallucinations

  • Parkinsonian motor features

  • Relatively early extrapyramidal features (vs may occur late in Alzheimer disease)

  • Anterograde memory loss: May be less prominent (vs prominent early sign in Alzheimer disease)

  • More prominent executive function deficits and visuospatial impairment (eg, Stroop, digit span backwards)

Other symptoms that may alert clinicians to the diagnosis of DLB (vs Alzheimer disease) include the following:

  • Nonvisual hallucinations

  • Delusions

  • Unexplained syncope

  • Rapid eye movement sleep disorder

  • Neuroleptic sensitivity

See Clinical Presentation for more detail.

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