What are the symptoms of Dementia with Lewy bodies? When should I suspect this disease?

Dementia with Lewy bodies is the second most common cause of neurodegenerative dementia after Alzheimer’s. It is frequently misdiagnosed as a psychiatric illness, focal seizures, or Alzheimer's. However, patients might have a combined process (pathology).
After you realize that you or your loved one is experiencing significant cognitive issues that can be classified as dementia, it's important to look for these four clinical features:
1. Cognitive fluctuations: These are very noticeable and unpredictable changes in concentration, attention, alertness, and wakefulness that can occur from day to day or even throughout the day. There may be periods of somnolence for hours, followed by being very awake the next day, or other periods of good days and very bad days. These fluctuations can sometimes be difficult for providers to detect, even during clinic visits. Although fluctuations can occur in Alzheimer's dementia, they are typically not part of the initial presentation.
2. Visual hallucinations: Approximately 80% of patients experience seeing things that aren't there, such as a cat, dog, or children playing. These hallucinations tend to be very well-formed and recurrent, rather than occurring only during periods of infection or post-surgery.
3. REM sleep behavior disorder (RBD): This occurs in approximately 76% of patients, and it involves acting out during sleep. Patients may be supposed to be paralyzed during REM sleep, but they instead move around and act out their dreams.
4. Parkinsonism: This occurs in approximately 85% of patients, although it may take some time to become evident. Patients might have slow movements, stiffness, or resting tremors, or they may have all three of these symptoms. It's important to be cautious in diagnosing Parkinsonism, as some patients may have significant arthritis that can make the examination more difficult. In some cases, a DAT scan may be necessary to confirm objectively parkinsonism. However, a normal DAT scan does not rule out dementia with Lewy bodies. You can learn more about when to order a DAT scan by watching my video, which has a link to the description of this video below.
The 5 main reasons to use a DAT Scan link:
• The 5 main reasons to ...
Are dementia and Alzheimer's the same thing? What is dementia? link:
• Are dementia and Alzhe...
Dr. Z
Luis E. Zayas, MD PT
Clinical Assistant Professor-University of Tennessee
Board Certified Internist & Neurologist
Fellowship trained in Movement Disorders and Neuro-Critical Care
Former NJ & PR physical therapist
DISCLAIMER:
*These videos are for education only and are not to be construed as personalized medical advice, and the content here does not constitute a patient-doctor relationship. Consult your own physician for any medical issues.