Lewy body dementia

Published on November 28, 2021   21 min

A selection of talks on Neuroscience

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Hello, my name is John-Paul Taylor. I am a professor of Translational Dementia Research at Newcastle University, United Kingdom. I'm going to be presenting today a summary of "Lewy Body Dementia", focusing on diagnosis, emerging concepts, and the management of this condition.
Before proceeding further, it is important to address the nomenclature of Lewy body dementia. Lewy body dementias are part of a spectrum of Lewy body diseases and include both Parkinson's disease dementia, PDD, and dementia with Lewy bodies, DLB. The two conditions are differentiated from each other on the basis of the timing of motor Parkinsonism symptoms relative to dementia onset. Typically PDD may manifest where there is established Parkinson's disease and then there is a subsequent cognitive decline and functional impairment as a result. In DLB the dementia occurs before or concurrently with Parkinsonism or within one year of onset of the motor symptoms. Splitting DLB from PDD at the moment is still arbitrary with the one-year rule and sometimes using the catch-all term of the Lewy body dementia is appropriate where the onset of either the motor or dementia symptoms is not entirely clear. For the purposes of the current presentation, it should be noted that the weight of the discussion is very much on DLB, although there are very strong overlaps in the management of both DLB and PDD.
A major problem for DLB is the underdiagnosis of the condition and a lack of a systematic approach to management. In people who have died with dementia, neuropathological interrogation of the brains demonstrates that 15-20 percent have evidence for Lewy body disease. Indeed some more recent reports suggest that this figure may be higher up to a quarter of people who have died with dementia may have evidence of Lewy body disease. In contrast in Parkinson's research studies have suggested that the diagnostic rates clinically are much lower, 4-7 percent and the rates may be even much lower again in routine clinical services. We know from several studies, for example, one here from Galvin and colleagues, that there is an under-recognition of DLB and many patients receive misdiagnosis, for example, of Alzheimer's disease. This is despite the fact that the quality of life for people living with DLB and their caregivers appears to be a lot lower than comparable dementias. A management of the condition is fractured between different clinical services.