Dementia with Lewy bodies is the second most frequent cause of hospitalization for dementia, after Alzheimer's disease. Current estimates are that about 60-to-75% of diagnosed dementias are of the Alzheimer's and mixed (Alzheimer's and vascular dementia) type, 10-to-15% are Lewy Bodies type, with the remaining types being of an entire spectrum of dementias including frontotemporal lobar degeneration, alcoholic dementia, pure vascular dementia, etc. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... For other uses, see Dementia (disambiguation). ... Frontotemporal lobar degeneration (FTLD) is a form of dementia. ...

Dementia with Lewy Bodies (DLB) exhibits clinical overlap between Alzheimer's disease and Parkinson's disease. Pathologically, it is characterized by development of abnormal proteinaceous (alpha-synuclein) cytoplasmic inclusions, called Lewy bodies, throughout the brain. These inclusions have similar structural features to "classical" Lewy Bodies seen subcortically in Parkinson's disease. Additionally, there is a loss of dopamine-producing neurons (in the substantia nigra) similar to that seen in Parkinson's disease, and a loss of acetylcholine-producing neurons (in the basal nucleus of Meynert and elsewhere) similar to that seen in Alzheimer's disease. Cerebral atrophy (or shrinkage) also occurs as the cerebral cortex degenerates. Autopsy series have revealed that the pathology of DLB is often concomitant with the pathology of Alzheimer's disease. That is, when Lewy Body inclusions are found in the cortex, they often co-occur with Alzheimer's disease pathology found primarily in the hippocampus, including: neurofibrillary tangles (abnormally phosphorylated tau protein), senile plaques (deposited beta-amyloid protein), and granulovacuolar degeneration. Alpha-synuclein is a normal protein found in the brain. ... Lewy bodies are abnormal aggregates of protein that develop inside nerve cells. ... Dopamine is a chemical naturally produced in the body. ... The substantia nigra, (Latin for black substance, Soemering) or locus niger is a heterogeneous portion of the midbrain, separating the pes (foot) from the tegmentum (covering), and a major element of the basal ganglia system. ... The chemical compound acetylcholine, often abbreviated as ACh, was the first neurotransmitter to be identified. ... In the lateral part of the tuber cinereum is a nucleus of nerve cells, the basal optic nucleus of Meynert. ... Location of the cerebral cortex Slice of the cerebral cortex, ca. ... The hippocampus is structurally located inside the medial temporal lobe of the brain. ... Neurofibrillary tangles are pathological protein aggregates found within neurons in cases of Alzheimers disease. ... Tau proteins are normal proteins found within the brain. ...

Within DLB, the loss of cholinergic (acetylcholine-producing) neurons is thought to account for the degradation of cognitive and emotional functioning as in Alzheimer's disease, while the loss of dopaminergic (dopamine-producing) neurons is thought to account for the degradation of motor control as in Parkinson's disease. Thus, DLB is similar in some ways to both the dementia resulting from Alzheimer's disease and Parkinson's disease. In fact, it is often confused in its early stages with Alzheimer's disease and/or vascular dementia (multi-infarct dementia). The overlap of neuropathologies and presenting symptoms (cognitive, emotional, and motor) may make an accurate differential diagnosis difficult to reach. Multi-infarct dementia, also known as vascular dementia, is a form of dementia resulting from brain damage caused by stroke or transient ischemic attacks (also known as mini-strokes). ...

Dementia with Lewy Bodies is not a DSM-IV recognized diagnosis. (Note: DSM-IV was published in 1994.) In 1996, a consortium of scientists initially proposed and later revised diagnostic guidelines. Central features of DLB include progressive cognitive decline, typically with impairments in memory, visual-spatial abilities, and/or attention. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ...

Clinical features

Core features include fluctuating cognition with variations in attention and alertness, recurrent visual hallucinations (typically early in the disease), and motor features of parkinsonism. DLB patients also often experience repeated falls, syncope (fainting), transient loss of consciousness, and hypersentivity to neuroleptic medications. Generally, DLB is diagnosed when cognitive symptoms develop within a year or two of movement disorder/Parkinsonian symptoms. Recent research suggests that presence of sleep disturbance may also be useful in differentiating DLB from other forms of dementia. A hallucination is a sensory perception experienced in the absence of an external stimulus, as distinct from an illusion, which is a misperception of an external stimulus. ...

Treatment

The treatment of DLB, as with Parkinson's disease, involves striking a balance between treating the motor and emotive/cognitive symptoms. Treatment of the movement portion of the disease can typically result in worsening hallucinations and psychosis, while treatment of the hallucinations and psychosis can result in worsening movement symptoms. The use of cholinesterase inhibitors represents the treatment of choice. This improves symptoms, but does not cure the disease. The use of memantine may be recommended, and may represent a means to slow or prevent the decline of cognitive function, although strong evidence to support or disprove this is lacking. A cholinesterase inhibitor or anticholinesterase is a chemical that inhibits a cholinesterase enzyme from breaking down acetylcholine, so increasing both the level and duration of action of the neurotransmitter acetylcholine. ...

Nomenclature

Dementia with Lewy bodies (DLB) is also known under a variety of other names including, Lewy Body dementia (LBD), Diffuse Lewy Body disease (DLBD), Cortical Lewy Body disease (CLBD), and Senile dementia of Lewy type. All incorporate the name Lewy, as Dr. Frederic Lewy (1885-1950) was first to discover the abnormal protein deposits ("Lewy Body inclusions") in the early 1900s.^[1][2] Frederic Henry Lewey (born Friedrich Heinrich Lewy, 1885 in Berlin - October 5, 1950 in Haverford, Pennsylvania) was a prominent neurologist. ... // First flight by the Wright brothers, December 17, 1903. ...

References

1. ^ http://www.rudramani.com/alzh.html/
2. ^ synd/2499 at Who Named It

Who Named It is a Norwegian database of several thousand eponymous medical signs and the doctors associated with their identification. ...

External links

• Laboratory for Alzheimer's and Parkinson's Disease Research - Prof. Dr. Christian Haass
• NINDS Dementia With Lewy Bodies Information Page
• Dementia Research News from ScienceDaily
• Lewy Body Dementia Association, Inc.
• lewybody.org