I ran across this 2006 article today in the American Family Physician journal. It’s a good, short description of dementia with Lewy bodies, intended for use by family practic physicians.
You can get the article free online at:
www.aafp.org/afp/20060401/1223.html –> in HTML
www.aafp.org/afp/20060401/1223.html –> in PDF
You might provide this article to your general/family practice MD!
The diagnostic criteria listed in Table 1 of the article is from 1996. The diagnostic criteria was updated in 2005. (The latest criteria are: McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 2005;65:186372.)
Figure 1 offers a good comparison of AD and DLB.
In the section on pharmacological treatment of DLB, the authors state: “Patients with significant visual hallucinations are reported to have better response to cholinesterase inhibitor therapy than other patients with dementia; these medications improve fluctuating cognition, hallucinations, apathy, anxiety, and sleep disturbances.” (ChEIs include Aricept, Exelon, and Razadyne.)
And: “Patients who have dementia with Lewy bodies should not be given the older, typical D2-antagonist antipsychotic agents such as haloperidol (Haldol), fluphenazine (Prolixin), and chlorpromazine (Thorazine). Patient records should document this and caregivers should be informed. As many as one half of patients who have dementia with Lewy bodies who receive neuroleptic medications experience life-threatening adverse effects characterized by sedation, rigidity, postural instability, falls, increased confusion, and neuroleptic malignant syndrome, with an associated two- to threefold increase in mortality. Atypical antipsychotics may be tried in low doses, but these can cause similar adverse effects and increase the risk of stroke.”
The associated summary handout for patients and families is very disappointing:
Copied below is the abstract of the article.
American Family Physician. 2006 Apr 1;73(7):1223-9.
Dementia with Lewy bodies: an emerging disease.Neef D, Walling AD.
Via Christi Family Medicine Residency, Wichita, Kansas 67218, USA.
Dementia with Lewy bodies appears to be the second most common form of dementia, accounting for about one in five cases. The condition is characterized by dementia accompanied by delirium, visual hallucinations, and parkinsonism. Other common symptoms include syncope, falls, sleep disorders, and depression. The presence of both Lewy bodies and amyloid plaques with deficiencies in both acetylcholine and dopamine neurotransmitters suggests that dementia with Lewy bodies represents the middle of a disease spectrum ranging from Alzheimer’s disease to Parkinson’s disease. The diagnosis of dementia with Lewy bodies is based on clinical features and exclusion of other diagnoses. Individualized behavioral, environmental, and pharmacologic therapies are used to alleviate symptoms and support patients and their families. Cholinesterase inhibitors are more effective in patients who have dementia with Lewy bodies than in those with Alzheimer’s disease. Conversely, patients who have dementia with Lewy bodies do not respond as well to antiparkinsonian medications. Anticholinergic medications should be avoided because they exacerbate the symptoms of dementia. Traditional antipsychotic medications can precipitate severe reactions and may double or triple the rate of mortality in patients who have dementia with Lewy bodies.
PubMed ID#: 16623209 (see pubmed.gov for abstract)