Dementia with Lewy bodies

Clinic

• DLB is a type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions.
• Together with Parkinson's disease dementia, DLB is one of the two Lewy body dementia.

Sign / Symptoms

• Memory loss is not always an early symptom
• REM sleep behavior disorder (RBD) is a core feature. It appears years or decades before other symptoms.

Other core features are

• Visual hallucinations
• Marked fluctuations in attention or alertness
• Parkinsonism (Slowness of movement, Trouble walking or Rigidity)
• Psychiatric symptoms, such as altered behavior, depression or apathy.
• Autonomic Dysfunction including
  • Heart function
  • Every level of GI function from chewing to defecation
  • Constipation
  • Hypotention upon standing can also occur.
  • Dysphagia (92%)
  • Pharyngeal dysfunction (96%)
  • Urgency and urge incontinence is more prevalent in DLB than in PD and Alzheimer disease.

Note:

• Visual hallucinations in DLB are generally vivid hallucinations of people or animals and often occur in falling asleep or waking up. So it's better to consider "Delirium" as an appropriate Miasmatic rubric.
• Abnormal sleep behaviors begin before cognitive decline and is a core feature of DLB.

• Memory loss is not always an early symptom

DBL Black Box

	FFI
RBD	+++
Delirium	+++
Parkinsonism	+++
Behavior change	+++
Dementia	+++
Constipation	+++
Dysphagia	+++