Cited by 63Parkinson's Disease Mechanisms and TreatmentsDementia and Cognitive Impairment ResearchNeurological disorders and treatments

Dementia with Lewy bodies: Challenges in the diagnosis and management

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Chin, Kai Sin, Teodorczuk, Andrew, Watson, Rosie·2019·Australian & New Zealand Journal of Psychiatry

Abstract

Objective: Dementia with Lewy bodies is the second most common form of neurodegenerative dementia in older age yet is often under-recognised and misdiagnosed. This review aims to provide an overview of the clinical features of dementia with Lewy bodies, discussing the frequent challenges clinicians experience in diagnosing dementia with Lewy bodies, and outlines a practical approach to the clinical management, particularly in the Australian setting. Methods: This paper is a narrative review and a semi-structured database (PubMed and MEDLINE) search strategy was implemented. Articles were screened and clinically relevant studies were selected for inclusion. Results: Dementia with Lewy bodies is clinically characterised by complex visual hallucinations, spontaneous motor parkinsonism, prominent cognitive fluctuations and rapid eye movement sleep behaviour disorder. Neuropsychiatric features and autonomic dysfunction are also common. The new diagnostic criteria and specific diagnostic biomarkers help to improve detection rates and diagnostic accuracy, as well as guide appropriate management. Clinical management of dementia with Lewy bodies is challenging and requires an individualised multidisciplinary approach with specialist input. Conclusion: Dementia with Lewy bodies is a common form of dementia. It often presents as a diagnostic challenge to clinicians, particularly at early stages of disease, and in patients with mixed neuropathological changes, which occur in over 50% of people with dementia with Lewy bodies. Prompt diagnosis and comprehensive treatment strategies are important in improving patients’ care.

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  • A narrative review and a Delphi consensus group supported donepezil and rivastigmine for neuropsychiatric symptoms of dementia with Lewy bodies, although a network meta-analysis found these drugs improved neuropsychiatric symptoms in Parkinson's disease dementia but not in dementia with Lewy bodies.

    “A narrative review 124 and a Delphi consensus group 125 supported the use of donepezil and rivastigmine for neuropsychiatric symptoms of dementia with Lewy bodies, although a network meta‐analysis found that these drugs improved neuropsychiatric symptoms in Parkinson's disease dementia, but not in dementia with Lewy bodies 123 .”

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Authors
Chin, K. S., Teodorczuk, A., & Watson, R.
Affiliations
  • The Royal Melbourne Hospital (AU)
  • Griffith University (AU)
Corresponding author
Chin, Kai Sin
Venue
Australian & New Zealand Journal of Psychiatry
Published
2019-03-08
Volume
53
Issue
4
Pages
291-303
ISSN
  • 0004-8674 (ISSN-L)
  • 1440-1614
OpenAlex
W2921301677
Cited by
63
References
99
Citations by year
2026: 6 · 2025: 9 · 2024: 13 · 2023: 16 · 2022: 11 · 2021: 6 · 2020: 2
FWCI
0.64
Type
journal article
Language
en
Open access
Locations
  • Australian & New Zealand Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Griffith Research Online (submittedVersion)
Funders
  • Yugilbar Alzheimer’s Research Program
  • Australian Commonwealth Government (Research Training Program Scholarship)
Topics
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
Keywords
dementia with Lewy bodies, Lewy bodies, misdiagnosis, diagnostic criteria, diagnostic biomarkers, visual hallucinations, parkinsonism, cognitive fluctuations, REM sleep behavior disorder, neuropsychiatric symptoms, autonomic dysfunction, multidisciplinary management, neurodegenerative dementia
MeSH terms
Alzheimer Disease, Diagnosis, Differential, Humans, Parkinson Disease, Disease Management, Lewy Body Disease

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