[Clinical features and treatment of dementia with Lewy bodies].

OBJECTIVE

To investigate the clinical, neuropsychological, neuroimaging features and treatment of dementia with Lewy bodies (DLB).

METHODS

The clinical, neuropsychological, neuroimaging and therapeutic features of 33 DLB patients were retrospectively analyzed.

RESULTS

There were 25 males and 8 females. The mean course from onset to diagnosis was 3.3 years. Sleep disorder, depression, anxiety and constipation were present at 1 - 10 years prior to DLB onset in 10 patients. Memory impairment (52%) and parkinsonism (21%) were initial symptoms. The mean duration from memory impairment to presence of parkinsonism was 17 months. Pattern of extrapyramidal signs showed bilateral, symmetry and axial muscles bias as postural instability and facial impassivity, tremor was less in DLB. Hallucination (70%), sleep disorder (63%), apathy (56%) and delusion (52%) were the major behavioral and psychological symptoms. Hallucination occurred within a mean of 15 months after presence of initial symptoms. Cognition impairment progressed rapidly in half of patients. Neuropsychological tests of mild patients revealed visuospatial dysfunction and relatively preservation of memory. Severe impairment of all domains of cognition was noticed in moderate-severe patients. MRI (magnetic resonance imaging) revealed the preservation of hippocampal structures. And PET (positron emission tomography) showed hypometabolism of occipital lobe. Cholinesterase inhibitors could improve cognitive impairment and behavioral symptoms in a large majority of patients.

CONCLUSION

Neuronal dysfunction may be present at an early stage of DLB. Early presence of hallucination, a high prevalence of sleep disorders, axial rigidity and hypometabolism of occipital lobe on PET may help to distinguish DLB from other types of dementia.