Demencia con cuerpos de Lewy: diagnóstico y tratamient
Dementia with Lewy bodies (DLB) has recently been recognized as a clinicopathological entity. It is currently thought that DLB may make up 15-25% of all the types of dementia, which means that it is the second commonest type of dementia after Alzheimer’s disease (AD). From the neuropathological point of view, the patients have Lewy bodies in the brain stem and cerebral cortex, especially in the frontal and temporal lobes and in the basal nucleus of Meynert. The neurotransmissors most involved are acetylcholine and dopamine. A series of clinical and pathological criteria have been established for the identification of this new condition (Consensus Guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies). From the clinical point of view, these criteria determine the probability of the diagnosis: probable (when the main characteristics of DLB are present) and possible when there is a possibility that the disorder may be present. DLB is considered to be definitely present when this is confirmed by pathology studies. The main characteristics of DLB are the presence of visual hallucinations, fluctuations in the sensorium and extrapyramidal signs (two of those systems should be present when making a diagnosis of probable DLB). Other symptoms which may also be seen in DLB are syncope, incontinence of urine, delirious ideas, frequent falls and abnormal response to treatment with neuroleptic drugs. The commonest differential diagnoses are AD, Parkinson’s disease with dementia, front-temporal dementia, progressive supranuclear paralysis, cortico basal degeneration and hydrocephalus with normal pressure. The main problem in clinical diagnosis of this disorder is that the same signs and symptoms may be seen as with AD (in most cases both conditions are present) and some patients with AD and Lewy bodies in the cerebral cortex do not develop the syndrome during the course of their illness. The study of DLB is fascinating and the relationship between AD and DLB is still not clear
