Lewy Body Dementia (LBD)
Lewy Body Dementia (LBD)
Lewy body dementia (LBD) is the second most common type of progressive dementia after Alzheimer’s disease. It is caused by abnormal deposits of a protein called alpha-synuclein (Lewy bodies) in brain cells, affecting regions involved in thinking, memory, movement, and autonomic functions16.
Key Symptoms
- Cognitive decline: Gradual loss of thinking abilities, attention, planning, problem-solving, and reasoning. Memory loss may occur but is often less prominent early on than in Alzheimer’s136.
- Fluctuating alertness: Marked variations in attention and confusion, sometimes resembling delirium67.
- Visual hallucinations: Seeing things that aren’t there, often well-formed and recurring. Auditory and tactile hallucinations can also occur146.
- Parkinsonism: Movement symptoms similar to Parkinson’s disease, including muscle stiffness, slowed movement, tremors, and shuffling walk157.
- REM sleep behavior disorder: Acting out dreams during sleep, sometimes preceding other symptoms by years56.
- Autonomic dysfunction: Problems with blood pressure, heart rate, sweating, digestion, and bladder control16.
Diagnosis
Diagnosis is based on clinical history, neurological examination, and cognitive testing. Key diagnostic features include dementia plus at least two of the following: fluctuating cognition, recurrent visual hallucinations, parkinsonian motor symptoms, and REM sleep behavior disorder579. Brain imaging (MRI, CT, PET, or SPECT) helps rule out other causes, but there is no single definitive test78.
Management
There is no cure for LBD. Treatment focuses on managing symptoms:
- Medications: Cholinesterase inhibitors for cognitive symptoms; levodopa for movement symptoms (with caution); melatonin or clonazepam for sleep issues5.
- Avoidance of certain antipsychotics: Many antipsychotic drugs can worsen symptoms or cause severe side effects in LBD patients15.
- Supportive care: Physical, occupational, and speech therapy; caregiver support; and management of autonomic symptoms.
Summary Table
| Aspect | Details |
|---|---|
| Cause | Alpha-synuclein (Lewy body) protein deposits in brain cells |
| Core Symptoms | Cognitive decline, fluctuating alertness, visual hallucinations, parkinsonism, REM sleep disorder, autonomic dysfunction |
| Diagnosis | Clinical evaluation, cognitive testing, brain imaging, symptom criteria |
| Treatment | Symptom management, cholinesterase inhibitors, cautious use of Parkinson’s medications, avoid antipsychotics, supportive care |
| Prognosis | Progressive and incurable, but symptom management can improve quality of life |
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References:
- Ferreira D, Kantarci K, et al. “Longitudinal FDG-PET Metabolic Change Along the Lewy Body Continuum.” JAMA Neurology. 2025.
DOI: 10.1001/jamaneurol.2024.4643
LBD is a complex dementia with overlapping features of Alzheimer’s and Parkinson’s diseases. Early recognition of its unique symptoms-especially visual hallucinations, fluctuating cognition, and parkinsonism-can improve diagnosis and care156.
