Clinical Features

Motor. In a study by Aarsland and colleagues (2001), parkinsonism was noted in 68 percent of a population of DLB patients with advanced disease. When compared to a community sample of PD patients, the DLB patients had more severe parkinsonism in general; no difference was noted in resting tremor. The parkinsonism of DLB is usually characterized by bradykinesia, limb rigidity, and gait disturbance. Other physical problems associated with DLB include syncopal spells and falling; these phenomena are seen in about one-third of DLB patients (McKeith, 2002).

Cognitive. Cognitive problems observed in DLB overlap to some extent with both PD and AD reflecting the combination of subcortical and cortical pathology in the disease. Slowed psychomotor skills and information processing are commonly reported as is visuospatial dysfunction (Knopman and Selnes, 2003). Attentional impairment is also a frequent and prominent accompaniment of DLB (Cullum et al., 2003) and may be related to the periods of transient unresponsiveness seen in DLB patients. The appearance of confusion is also prominent in patients with DLB, and the confusion and attentional impairment may lead to a misdiagnosis of delirium. Memory dysfunction is associated with DLB, although it appears to be less severe than in AD (Heyman et al., 1999). However, memory assessment is often complicated by disrupted attention and generally disorganized cognition. As is the case with PD, some studies have reported executive dysfunction and a reduction in verbal fluency (Knopman and Selenes, 2003).

Neuropsychiatric. Psychopathology is frequently seen in DLB patients. Approximately two-thirds of DLB patients have visual hallucinations at some point in their illness. The visual hallucinations of DLB are more persistent than those seen in other illnesses and are characteristically well formed and detailed. Patients often report hallucinations of people and animals that make no noise. Hallucinations in other sensory modalities can be seen in DLB, as can delusions. The delusions of DLB are often related to the content of the visual hallucinations and can be complex and bizarre. About 40 percent of DLB patients will have a major depressive episode; this rate is similar to that seen in patients with PD and is greater than that seen with AD (McKeith, 2002). Rapid eye movement (REM) sleep behavior disorders also occur in patients with DLB.

It is important to note that fluctuation is a hallmark of DLB. Fluctuation is noted in approximately 75 percent of DLB patients at some point in their illness. Symptom fluctuation coupled with attentional impairment and psychosis can lead to a misdiagnosis of delirium.

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Anxiety and Depression 101

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