Dementia with Lewy bodies: The emerging role of primary care

Dementia with Lewy bodies (DLB) is an under recognized but frequent subtype of dementia. Misdiagnosis and delays in referral from primary care are common when compared to other forms of dementia.

We present a case of a 63-year-old man who was eventually diagnosed with DLB three and a half years after his initial presentation.

Core features of DLB such as hallucinations, Parkinsonism and fluctuating levels of cognition need to be recognized in primary care as being part of the DLB phenotype. DLB is a complex and debilitating neurodegenerative disorder often requiring multidisciplinary support to enable affected individuals to live well in the community. Carers of DLB patients often develop higher levels of subjective burden compared to carers of patients with other forms of dementia; this needs to be recognized and managed appropriately. There is limited research into the role of primary care physicians in DLB. Efforts should be made to reduce delays in identification.

Primary care has an important role in identifying those who are at risk for DLB and in referring these patients timely to the appropriate specialist. Adequate management of these patients in the community might reduce the burden associated with the DLB phenotype.