Lewy Body Dementias

Lewy body dementia (LBD) includes both Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) and affects between 1 and 2 million older Americans. LBD is a multi-system disorder, involving disturbances of movement, cognition, behavior, sleep and autonomic function. LBD consensus diagnostic criteria exist but are somewhat lacking in sensitivity. Diagnosis of LBD is complicated by overlapping symptoms with the pure dementia phenotype of Alzheimer’s disease (AD), the pure motor phenotype of PD, and psychotic and behavioral features common in psychiatric disease. Early diagnosis is critical as LBD patients may respond differently than AD patients to certain dementia and behavioral treatments. Traditional neuroleptics should be avoided, due to potentially severe side effects. Optimum management of LBD includes both pharmacological and non-pharmacological treatments for the patient, and education and support for caregivers. This chapter reviews current knowledge of LBD aimed at facilitating early diagnosis and knowledge of LBD treatment options.