presentation

1. Lewy Body Dementia
Diagnosis and Treatment
Drew Chenelly, Psy.D.

2. Clinical Features
 Visual hallucinations.
 Parkinsonism.
 Paranoid delusions.
 Neuroleptic sensitivity.
 Syncope and falls.
 Progressive dementia.
 Rapid shifts in mood and behavior.
 Fluctuating levels of arousal and
cognition.

3. LBD Parkinson’s
Signs
 Masked facies.
 Shuffling gait.
 Rigidity.
 Bradykinesia.
 Stooped posture.
 Visuospatial function.
 Attention.
 Verbal fluency.
 Executive function.
LBD Neuropsychological
Impairments

4. What are Lewy bodies ?
Small round neuronal inclusions composed
of altered neurofilament proteins.

5. Who is affected and how ?
 25% of dementia pts.
 Males twice as often.
 Average course 5 yrs.
 Early onset.
 Two types of Lewy body dementia.
 Appearance of dementia before
Parkinson’s signs.
 Intellectual functioning better preserved
than in Alzheimer's dementia.
 30% with Sxs of depression.

6. Diffuse Lewy Body Disease
(DLBD)
 Widespread cortical and subcortical
Lewy body formation.
 Presents at an early age.
 Moderate Parkinsonism.
 Rapid course.
 Severe psychotic symptoms.
 Patchy cognitive impairment.

7. Lewy body variant of
Alzheimer's Disease (LBV)
 Brains contain plaques and
neurofibrillary tangles, as well as,
Lewy bodies.
 Presents at late age.
 Mild Parkinson’s signs.
 Global cognitive impairment.

8. Differential Diagnosis
LBD PD DAT VaD
Dementia Early Late Gradual Stepwise
EPS Mild,
Parkinson
S Tremor
Severe,Parkins
on
C Tremor
Late
Rigidity
10 Gait
Fluctuation Sustained None None Diurnal
Syncope Common None None Common
Visual
Hallucinations
Persistent
Well formed
Levodopa
Induced?
Late
Vague
Delirium-like
Episodes
Delusions Persecutor
y
Infidelity Misidentificati
on
Paranoia
Other Med
sensitivity
Course Memory Risk

9. Medication Rx
 Cholinesterase inhibitors:
rivastigmine…donepezil
 Antiparkinson agents: Sinemet
 Atypical antipsychotics:
quetiapine…olanzapine
 Antidepressants: Zoloft…Remeron

10. Behavior Management
 Avoid stimulating situations.
 Provide care when resident is
calm.
 Soothing environment in room.
 Pleasurable activity to
discharge excess energy.
 Predictable routine with rest
periods.

11. Responding
 Move and speak slowly.
 Do not rush or reason with
resident.
 Use no choice instruction.
 Do not ask questions.
 Use the resident’s name.
 Distract with object or music.
 Do not challenge delusions or
hallucinations.