Lewy Body Dementia: Case Report and Discussion

Natan Khotianov, MD, Ranjit Singh, MBBChir, MA(Cantab), Sonjoy Singh MBBChir, MA(Cantab)

Disclosures

J Am Board Fam Med. 2002;15(1) 

In This Article

Abstract and Introduction

Background: Lewy body dementia is a common but frequently underdiagnosed cause of dementia often mistaken for the more familiar entity of Alzheimer disease. Clinically the distinction is important, because it can have profound implications for management.
Methods: The medical literature was searched using the keywords "Lewy bodies," "Lewy body dementia," "Alzheimer dementia," and "parkinsonian disorders." A case of Lewy body dementia is described.
Results: An elderly man had long-standing diagnoses of Alzheimer disease and Parkinson disease. After he was evaluated thoroughly, the diagnosis was revised to Lewy body dementia, leading to changes in treatment that were associated with dramatic improvement in the patient's mental status. Evidence from the literature suggests that Lewy body dementia can be diagnosed in primary care settings based on clinical criteria. The physician should be alert to this diagnosis, and special attention should be paid to dementia patients who exhibit parkinsonism, hallucinations, fluctuating cognition, or prominent visuosperceptual deficits.
Conclusions: The diagnosis of Lewy body dementia has important implications. It is associated with a high incidence of neuroleptic sensitivity, necessitating great caution in the use of these common antipsychotic agents. Early studies indicate cholinesterase inhibitors can be beneficial for treating the hallucinations and behavior disturbances that afflict these patients and might also improve cognition.

Lewy body dementia is a common cause of dementia in the elderly, accounting for perhaps 15% to 25% of dementia cases.[1,2] Evidence suggests that Lewy body dementia might be underdiagnosed, often being mistaken for the more familiar Alzheimer disease. Clinically the distinction is important, as it can have profound implications for management and prognosis. An alternative diagnosis of Lewy body dementia can lead to a trial of treatment that can be associated with dramatic improvement in the patient's symptoms.

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