Dementia with Lewy bodies: clinical diagnosis and therapeutic approach

Dementia with Lewy bodies is one of the most common dementias in the elderly after Alzheimer's disease. It can be recognized on the basis of several clinical characteristics including progressive dementia with marked slowing and fluctuations, persistent visual hallucinations and an extrapyramidal syndrome. Several other clinical and imaging features are highly suggestive such as the presence of rapid eye movement sleep disorder, severe sensitivity to neuroleptics and specific neuroimaging abnormalities. Therapeutic strategies include prescription of L-dopa and cholinesterase inhibitors such as rivastigmine, and avoidance of anticholinergic medications and neuroleptics. Physicians who care for older people should have a heightened awareness of this entity in order to diagnose it early, avoid mistaking it for delirium and initiate appropriate treatment.