Dementia with cerebral Lewy bodies. A mesocortical dopaminergic defect?

We describe a patient with dementia who at postmortem examination was found to have Lewylike bodies throughout the cerebral cortex associated with typical Lewy bodies in the pigmented brainstem nuclei. Moderate numbers of senile plaques but no neurofibrillary tangles were found in the neopallium or in the limbic areas. A positive correlation was found between the distribution of the cortical Lewylike bodies and the proposed distribution of dopamine terminals in the cerebral cortex. Cell loss in the ventral tegmental area and the basal nucleus of Meynert suggest abnormalities in the dopaminergic and cholinergic innervation of the cerebral cortex. The relative lack of senile changes of Alzheimer type make these two proposed abnormalities a more plausible explanation for the dementia in this patient.