Lewy Body-Related Dementia or Parkinson's Disease?
Lewy Body-Related Dementia or Parkinson's Disease?
A patient in his 70s with presumed Parkinson's disease was evaluated by a neuropsychologist. This clinician diagnosed probable dementia with Lewy bodies, rather than true Parkinson's disease. What is the precise relationship between these 2 illnesses, and is there any help/hope for someone with such a dementia?
Lewy body-related dementia is considered a condition in which there is both cognitive decline and parkinsonian features. Both mental and motor symptoms tend to develop in concert. In contrast, profound mental changes are uncommon in the first 5 years of Parkinson's disease; most mental changes occur late in the disease. Compare this with Alzheimer's disease, in which parkinsonian signs occur later in the course of the illness. Lewy body dementia also has some distinguishing features, such as a fluctuating cognitive status and hallucinations among patients who are not receiving medications.
Antiparkinsonian drugs are not very effective in controlling motor aspects of the illnesses. Sometimes there is an initial response, but this beneficial effect tends to diminish with time. Furthermore, dopaminergic drugs may worsen mental status. There is some evidence that cholinesterase inhibitors, such as donepezil or rivastigmine, may stabilize the mental decline seen in this disease. This illness, like most neurodegenerative diseases, is a progressive process; therefore, the long-term prognosis is poor.
A patient in his 70s with presumed Parkinson's disease was evaluated by a neuropsychologist. This clinician diagnosed probable dementia with Lewy bodies, rather than true Parkinson's disease. What is the precise relationship between these 2 illnesses, and is there any help/hope for someone with such a dementia?
Lewy body-related dementia is considered a condition in which there is both cognitive decline and parkinsonian features. Both mental and motor symptoms tend to develop in concert. In contrast, profound mental changes are uncommon in the first 5 years of Parkinson's disease; most mental changes occur late in the disease. Compare this with Alzheimer's disease, in which parkinsonian signs occur later in the course of the illness. Lewy body dementia also has some distinguishing features, such as a fluctuating cognitive status and hallucinations among patients who are not receiving medications.
Antiparkinsonian drugs are not very effective in controlling motor aspects of the illnesses. Sometimes there is an initial response, but this beneficial effect tends to diminish with time. Furthermore, dopaminergic drugs may worsen mental status. There is some evidence that cholinesterase inhibitors, such as donepezil or rivastigmine, may stabilize the mental decline seen in this disease. This illness, like most neurodegenerative diseases, is a progressive process; therefore, the long-term prognosis is poor.
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