Dementia with Lewy bodies

Pathophysiology

• Alpha-synuclein inclusions (Lewy bodies)

Diagnosis

• Fluctuation in cognition over days or weeks
• Recurrent visual hallucinations that are typically well-formed and non-threatening
• Parkinsonism
• REM sleep behaviour disorder, which can precede the diagnosis by years
  • Occurs hours after sleeping
  • May notice tangled sheets on waking
• Numerous supporting features
• Biomarkers on SPECT/PET, myocardial scintigraphy, polysomnography

Management

• Cholinesterase inhibitors (especially rivastigmine)
• Do NOT use first-generation antipsychotics
  • Can try quetiapine or olanzapine