DEMENTIA WITH LEWY BODIES
(DIFFUSE LEWY BODY DISEASE)
Philip A. Hanna, M.D.
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
What is Parkinsonism-Dementia (Diffuse Lewy Body Disease)?
Dementia refers to marked memory loss with a decline in the ability to
process, store, and retrieve new information or memories. The major
cause of dementia in the elderly is Alzheimer's disease, which is due
to a progressive decline of cells (neurons) in the cortex (surface) of
the brain. Severe dementia can be associated with agitation,
disorientation, confusion, and hallucinations, which may necessitate
close supervision by care takers. Dementia eventually occurs in about
one-third of Parkinson's disease patients, while nearly one-third of
Alzheimer's disease patients develop signs of parkinsonism, such as
tremor, rigidity, slowness of movement, and postural instability.
Treatment of a patient who has a combination of parkinsonism and
dementia may be difficult if the patient is agitated and actively
hallucinating (seeing things that are not really there). The problem
is that the conventional drugs for suppression of hallucinations, such
as thioridazine (Mellaril®) or haloperidol (Haldol®), can worsen
parkinsonian symptoms. Newer medications such as clozapine (Clozaril®),
olanzapine (Zyprexa®) and quetiapine fumarate (Seroquel®) can help
control hallucinations without worsening parkinsonian symptoms.
However, clozapine can cause loss of infection-fighting white blood
cells in 1-2% of cases, a serious side effect which limits the
usefulness of this drug, secondary to the need for blood draws every
1-2 weeks.
Litvan I. Parkinsonian-Dementia Syndromes. In: Jankovic J, Tolosa E,
eds. Parkinson's Disease and Movement Disorders, 3rd edition, Williams
and Wilkins, Baltimore, Maryland, 1998:819-837.
Jankovic J. Treatment of Parkinsonian Syndromes. In: Kurlan R, ed. The
Treatment of Movement Disorders. J.B. Lippincott Company,
Philadelphia, 1995:95-114.
McKeith IG, Fairbairn AF, Bothwell RA, et al. An evaluation of the
predictive validity and inter-rater reliability of clinical diagnostic
criteria for senile dementia of Lewy body type. Neurology 1994;
44:872-877.
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