What is Lewy body dementia (LBD)?

From the Guidelines

Lewy body dementia (LBD) is a progressive brain disorder characterized by abnormal protein deposits called Lewy bodies that develop in nerve cells, and it is the second most common type of dementia after Alzheimer's disease, associated with a poorer prognosis, higher healthcare costs, and greater impact on quality of life 1.

Key Characteristics of LBD

• LBD typically causes problems with thinking, movement, behavior, and mood
• Patients often experience visual hallucinations, fluctuating cognition with varying levels of alertness and attention, movement disorders similar to Parkinson's disease, sleep disturbances, and autonomic dysfunction

Treatment and Management

• Treatment typically involves medications like cholinesterase inhibitors (rivastigmine, donepezil) for cognitive symptoms, levodopa for movement problems, and antipsychotics (specifically quetiapine or clozapine) used cautiously for hallucinations or delusions 1
• Management requires a careful balance of medications, as people with LBD are often extremely sensitive to certain drugs, particularly traditional antipsychotics which can cause severe, sometimes life-threatening reactions

Disease Progression and Outcome Measures

• The disease progresses over time, typically spanning 5-8 years from diagnosis
• LBD occurs because alpha-synuclein protein abnormally accumulates in brain cells, disrupting chemical messages and causing cell death
• The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial, and existing outcome measures require validation in the LBD population, with a need for LBD-specific outcomes to be developed 1

From the Research

Definition and Characteristics of Dementia with Lewy Bodies

• Dementia with Lewy bodies is a common form of dementia in the elderly, characterized by fluctuating cognitive impairment, attention deficits, visual hallucinations, parkinsonism, and other neuropsychiatric features 2, 3.
• The disease is often under-recognized and misdiagnosed, and its clinical management can be challenging due to the complexity of its symptoms 3.
• Characteristic symptoms include dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations, and spontaneous motor features of Parkinsonism 4.

Clinical Features and Diagnosis

• Dementia with Lewy bodies is clinically characterized by complex visual hallucinations, spontaneous motor parkinsonism, prominent cognitive fluctuations, and rapid eye movement sleep behavior disorder 3.
• Neuropsychiatric features and autonomic dysfunction are also common in patients with dementia with Lewy bodies 3.
• The new diagnostic criteria and specific diagnostic biomarkers can help improve detection rates and diagnostic accuracy, as well as guide appropriate management 3.

Treatment and Management

• Cholinesterase inhibitors, such as rivastigmine, may be beneficial in the treatment of dementia with Lewy bodies, particularly in improving cognitive deficits and neuropsychiatric symptoms 2, 4, 5, 6.
• Rivastigmine has been shown to produce statistically and clinically significant behavioral effects in patients with dementia with Lewy bodies, and seems safe and well tolerated if titrated individually 2.
• Clinical management of dementia with Lewy bodies requires an individualized multidisciplinary approach with specialist input, and prompt diagnosis and comprehensive treatment strategies are important in improving patients' care 3.