Journal scan

Lack of research about dementia with Lewy bodies

Review of Mueller C, Ballard C, Corbett A et al (2017) The prognosis of dementia with Lewy bodies. The Lancet. Neurology. 16, 5, 390-398. 

Review of Mueller C, Ballard C, Corbett A et al (2017) The prognosis of dementia with Lewy bodies. The Lancet. Neurology. 16, 5, 390-398. 

Brain_activity_in_Lewy_body_dementia
PET scan showing brain activity in a person with dementia with Lewy bodies. Picture: iStock

Dementia with Lewy bodies, which is characterised by clumps of protein that develop inside nerve cells in the brain, accounts for 10%-20% of dementia cases. Cognitive symptoms start with visuospatial and executive functions rather than with memory. Psychiatric and behavioural features, especially hallucinations, sleep disturbances and apathy, are common and frequently present early in the course of the disease.

Symptoms tend to fluctuate, which makes them difficult to assess. Patients with dementia with Lewy bodies have a faster cognitive decline than those with Alzheimer’s disease. They are also more likely to be admitted to residential care because behavioural problems, including aggression and psychotic episodes, make it difficult for carers to manage at home.

These patients also have a high risk of severe sensitivity to antipsychotic drugs. Acetylcholinesterase inhibitors, however, appear to be protective. Dementia with Lewy bodies risks being misdiagnosed as delirium because the visual hallucinations, and fluctuating attention and cognition, give a similar presentation to hyperactive delirium or acute confusional state. This can lead to patients being treated with antipsychotics, leading to a substantial risk of severe reactions and mortality. Conversely, increased confusion may be seen as a feature of the dementia when it is due to an infection or other treatable conditions.

This survey highlighted the importance of explaining Lewy body disease and its effects on the brain and the body as a whole. It is a devastating and costly condition, but has been subject to far less research and is less well understood than Alzheimer’s disease.


Reviewed by Ruth Sander, independent consultant in care of the older person

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