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Lewy body dementia (LBD, or Lewy body disorder) is an umbrella term that encompasses two dementias characterized by abnormal deposits of the protein alpha-synuclein in the brain:


 * dementia with Lewy bodies (DLB), and
 * Parkinson's disease dementia (PDD).

Lewy body dementia is considered to consist of the two related disorders (DLB and PDD) that are distinguished by the timing when cognitive and motor symptoms appear. The two conditions have similar features, may have similar causes, and can be viewed as part of a spectrum. They are more often misdiagnosed than any other common dementia.

Lewy body dementia is a neurodegenerative disease that is responsible for 5-25% of dementias and is more common in older adults. The synucleinopathies (DLB, PDD, and Parkinson's disease) are characterized by shared features of parkinsonism motor symptoms, neurophyschiatric symptoms, impaired cognition, sleep disorders, and visual hallucinations. Those with Lewy body dementia are more likely to experience hallucinations and may be more likely to experience delusions compared to other types of dementia. A core feature is REM sleep behavior disorder (RBD), in which individuals lose normal muscle paralysis during REM sleep, and act out their dreams. Other frequent symptoms include visual hallucinations; marked fluctuations in attention or alertness; and slowness of movement, trouble walking, or rigidity. The autonomic nervous system is usually affected, and can result in symptoms such as changes in blood pressure, heart and gastrointestinal function, urinary incontinence, and constipation. Mood changes such as depression and apathy are common.

RBD may appear decades before any other symptoms. On autopsy, 94 to 98% of individuals with polysomnography-confirmed RBD are found to have a synucleinopathy—most commonly DLB or Parkinson's disease, in about equal proportions. Other symptoms of the specific synucleinopathy usually manifest within 15 years of the diagnosis of RBD, but may emerge up to 50 years after RBD diagnosis.

Treatment

Unfortunately, there is no disease modifying medications to treat Lewy bodies dementia. Management of the disease process is mostly symptom treatment. Due to the variation of symptoms, the challenges are high sensitivity to drug-induced adverse effects, however, one medication might improve one symptoms and worsen another.