Assistência de enfermagem em pacientes com Demência do Corpo de Lewy / Nursing assistance in patients with Lewy's Body Dementia

Objetivo: Investigar sobre a assistência de Enfermagem a pacientes com Demência do Corpo de Lewy. Método: Revisão integrativa da literatura, pela busca nas bases de dados, entre os anos de 2009 a 2021, utilizando os descritores: Doença por corpos de Lewy, Doença de Alzheimer, Doença de Parkinson, Assistência de Enfermagem. Resultado: A Demência do Corpo de Lewy é uma doença de difícil diagnóstico, por causa das semelhanças com as Doenças de Alzheimer e Parkinson, seu tratamento é baseado nessas patologias, não seguindo protocolos específicos da doença. A enfermagem tem por função principalmente orientar a família e oferecer uma assistência integral tanto para o paciente, quanto para o cuidador. Conclusão: É necessária, a realização de mais estudos, para entender como assistir um paciente diagnosticado com esta patologia adequadamente, dando suporte para um cuidado de enfermagem mais científico e integral, estabelecendo rotinas, promoveno assim qualidade de vida ao paciente e sua família.(AU)

Objective: To investigate Nursing care for patients with Lewy Body Dementia. Method: Integrative literature review, using the Scielo database, between 2009 and 2021, using the descriptors: Lewy body disease, Alzheimer's disease, Parkinson's disease, Nursing care. Result: Lewy Body Dementia is a disease that is difficult to diagnose, because of the similarities with Alzheimer's and Parkinson's Diseases, its treatment is based on these pathologies, not following disease-specific protocols. Nursing's main function is to guide the family and offer comprehensive care for both the patient and the caregiver. Conclusion: Further studies are needed to understand how to properly care for a patient diagnosed with this pathology, supporting a more scientific and comprehensive nursing care, establishing routines, thus promoting quality of life for patients and their families.(AU)

Objetivo: Investigar el cuidado de Enfermería a pacientes con Demencia con Cuerpos de Lewy. Método: Revisión integrativa de la literatura, utilizando la base de datos Scielo, entre 2009 y 2021, utilizando los descriptores: Enfermedad de cuerpos de Lewy, Enfermedad de Alzheimer, Enfermedad de Parkinson, Cuidados de enfermería. Resultado: La Demencia con Cuerpos de Lewy es una enfermedad de difícil diagnóstico, debido a las similitudes con el Alzheimer y el Parkinson, su tratamiento se basa en estas patologías, no siguiendo protocolos específicos de la enfermedad. La función principal de enfermería es orientar a la familia y ofrecer una atención integral tanto al paciente como al cuidador. Conclusión: Se necesitan más estudios para comprender cómo cuidar adecuadamente a un paciente diagnosticado con esta patología, apoyando un cuidado de enfermería más científico e integral, estableciendo rutinas, promoviendo así la calidad de vida de los pacientes y sus familias.(AU)

The clinical value of 123I-metaiodobenzylguanidine myocardial imaging in the diagnosis of dementia with Lewy bodies / 生物医学工程学杂志

Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine that accumulates in sympathetic nerve endings soon after intravenous administration. The degree of accumulation reflects the uptake, storage and release of transmitters by noradrenergic neurons. Myocardial imaging with 123I labeled MIBG ( 123I-MIBG) can be used to estimate the extent of local myocardial sympathetic nerve damage, which has been widely used in the diagnosis and treatment of various heart diseases. In recent years, numerous studies have been carried out on the application of 123I-MIBG in the diagnosis of degenerative diseases of the nervous system (such as Parkinson's disease and dementia of Lewy body), and have made some achievements. The purpose of this review is to summarize the current clinical application of 123I-MIBG myocardial imaging in the diagnosis of dementia with Lewy bodies, the problems in imaging technology and the possible research directions in the future, so as to provide valuable reference information for clinicians to reasonably and accurately apply this technology in the early diagnosis and discrimination of dementia.

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia / Diagnosis and management of Parkinson's disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

RESUMO A demência da doença de Parkinson (DDP) e a demência com corpos de Lewy (DCL) representam a segunda causa mais comum de demência neurodegenerativa em pessoas com mais de 65 anos, ocasionando progressivo declínio cognitivo e comprometimento da qualidade de vida. O presente estudo tem como objetivo prover um consenso de especialistas sobre a DDP e DCL, baseado em revisão sistemática da literatura brasileira e revisão não-sistemática de literatura internacional. Ademais, tal estudo visa promover informação e conceder recomendações sobre abordagem diagnóstica, com foco nos níveis de atenção primária e secundária em saúde. Com base nos dados disponíveis, recomendamos que os profissionais realizem pelo menos um breve instrumento cognitivo global, como o Mini-Exame do Estado Mental, contudo de preferência optem pela Avaliação Cognitiva de Montreal e o Exame Cognitivo de Addenbrooke-Revisado. Observa-se uma carência de instrumentos validados para a avaliação precisa das habilidades funcionais em pacientes brasileiros com DDP e DCL. Além disso, mais estudos focando em biomarcadores com coortes brasileiras também são necessários.

ABSTRACT Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) represent the second most common type of degenerative dementia in patients aged 65 years and older, leading to progressive cognitive dysfunction and impaired quality of life. This study aims to provide a consensus based on a systematic Brazilian literature review and a comprehensive international review concerning PDD and DLB. Moreover, we sought to report on and give recommendations about the best diagnostic approaches focusing on primary and secondary care. Based on the available data, we recommend clinicians to apply at least one brief global cognitive instrument to assess PDD, such as the Mini-Mental State Examination and preferably the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised. Validated instruments to accurately assess functional abilities in Brazilian PD patients are still incipient. Further studies should focus on biomarkers with Brazilian cohorts.

Cambios en la marcha asociados con demencia por cuerpos de Lewy: una revisión narrativa de la literatura / Gait changes associated with Lewy body dementia: a narrative review of the literature

RESUMEN INTRODUCCIÓN: La demencia por cuerpos de Lewy (DCL) es una enfermedad neurodegenerativa con alta prevalencia y a menudo subdiagnosticada. En las demencias pueden presentarse alteraciones en la marcha que potencialmente permitan identificar su subtipo y dar una orientación clínica, diagnóstica y terapéutica temprana. Esta revisión narrativa de la literatura busca revisar los cambios de la marcha que se han descrito asociados con DCL. MATERIALES Y MÉTODOS: Se realizó una revisión de la literatura sobre la relación de las alteraciones de la marcha con la DCL. Se seleccionaron los siguientes parámetros de búsqueda mediante el buscador Scopus: ((falls and dementia and gait and (evaluation or analysis))). Los datos se ordenaron según relevancia y se obtuvieron 267 resultados. Igualmente, se hizo una búsqueda en PubMed, para a la que se introdujeron los términos (gait and lewy-body-disease), y no se utilizaron otros filtros; se obtuvieron 139 resultados. Se hizo una selección no sistemática de los artículos para llevar a cabo una revisión narrativa acerca de los cambios en la marcha asociados con DCL. RESULTADOS: Las alteraciones en la marcha pueden tener un valor predictor importante en la DCL. Los pacientes con demencias no debido a EA o causas vasculares muestran un deterioro de la funcionalidad física más rápido comparado con pacientes con EA y sin problemas cognitivos. La priorización incorrecta de las tareas, evidenciada en la EP, también es observable en los pacientes con DCL, y se asocia con el paradigma de doble tarea en el paciente con trastorno neurocognitivo mayor. El congelamiento de la marcha, también conocido como bloqueo de la marcha, se ha asociado con mayor progresión de la alteración cognitiva. Los pacientes con DCL también presentan un mayor compromiso en el tiempo de balanceo y la variabilidad de duración de la zancada, como también peor desempeño en ritmo y variabilidad de la marcha, e inestabilidad de la marcha, con posturas inadecuadas. CONCLUSIONES: Existe una relación entre la DCL y las caídas en el adulto mayor. En este grupo de edad, los cambios en la marcha y en las pruebas de desempeño podrían tener una utilidad clínica como factores asociados a con DCL, así como con las caídas. Al parecer, existe una variación característica entre los parámetros de la marcha y los subtipos de demencias que puede tener un valor como marcador diagnóstico. Se requieren más estudios con respecto a este tema puesto que hay escasa evidencia disponible hasta el momento, lo cual impide definir con mayor precisión las alteraciones más sensibles de cada dominio de la marcha que permitan diferenciar el envejecimiento normal del patológico.

ABSTRACT INTRODUCTION: Lewy body dementia is a highly prevalent neurodegenerative disease and often goes unnoticed due to little knowledge about it. In dementias there may be gait alterations that potentially allow the identification of its subtype and provide early clinical, diagnostic, and therapeutic guidance. This narrative review of the literature aims to review gait changes that have been described as associated with Lewy body dementia. MATERIALS AND METHODS: A literature review was carried out on the relationship of gait disturbances and LBD. The following search parameters were selected using the Scopus search engine: ((falls and dementia and gait and (evaluation or analysis))). The data were ordered according to relevance, obtaining 267 results. Likewise, a search was made in PubMed, using the terms (gait and lewy-body-disease), and no other filters were used, obtaining 139 results. A non-systematic selection of literature was made to carry out a narrative review about the changes in gait associated with LBD. RESULTS: We found that gait disturbances may have an important predictive value in LBD. Patients with dementias not due to AD or vascular causes have a faster deterioration of physical function compared to patients with AD and without cognitive problems. The incorrect prioritization of tasks evidenced in PD is also observable in patients with LBD and is associated with the "dual-task" paradigm in patients with major neurocognitive disorder. Freezing of gait, also known as motor block or "freezing of gait" has been associated with a greater progression of cognitive impairment. Patients with LBD also show greater compromise in swing time, stride duration variability, poorer performance in gait pace and variability, and gait instability with inappropriate postures. CONCLUSIONS: We observe that there is a relationship between LBD and falls in the elderly. Changes in gait and performance tests could have clinical utility as factors associated with LBD as well as falls in the elderly. There appears to be a characteristic variation between gait parameters and dementia subtypes that may have value as a diagnostic marker. More studies are required on this subject since there is little evidence available to date, which makes it impossible to define with greater precision the most sensitive alterations in each domain of gait that make it possible to differentiate normal from pathological aging.

Role of positron emission tomography in etiological evaluation of patients with dementia / 国际脑血管病杂志

Dementia is a syndrome mainly characterized by acquired cognitive impairment, which is mainly manifested by the decrease of cognitive functions such as understanding, orientation, and visuospatial ability. Due to different intervention methods for different types of dementia, differential diagnosis is extremely important. Positron emission tomography (PET) can reflect the changes of brain function from multiple angles through different tracers, providing imaging basis for the differential diagnosis of dementia. This article reviews the characteristics of PET in patients with different types of dementia in order to provide ideas for the differential diagnosis of patients with different types of dementia.

Analysis of visual scores of brain magnetic resonance imaging features of dementia with Lewy bodies / 中华老年医学杂志

Objective:To assess the practical value of visual scores of magnetic resonance imaging(MRI)features in the diagnosis and classification of dementia with Lewy bodies(DLB).Methods:In this study, 102 DLB patients were prospectively recruited, with 102 cognitively normal elderly people as the normal control group(NC).All included subjects underwent MRI examinations and neuropsychological assessments.Based on the clinical dementia rating(CDR)scale, DLB patients were divided into a mild(CDR=1.0), a moderate(CDR=2.0)and a severe(CDR=3.0)group.The results of MRI were scored visually and the rating scales included medial temporal lobe atrophy(MTA), global cortical atrophy-frontal subscale(GCA-F), posterior cortical atrophy(PCA), white matter lesions(the Fazekas scale), cerebral microbleeds(CMBs), and the Evans Index(EI).Statistical differences were compared between the DLB and NC groups and between DLB patients with different degrees of cognitive impairment.Results:In terms of neuropsychology, the Mini-Mental State Examination(MMSE) score of the DLB group[16.0(11.0, 21.0)]was statistically significantly lower than that of the NC group[29.0(28.0, 30.0)]( Z=-12.31, P<0.001), the Montreal Cognitive Assessment(MoCA)score of the DLB group[9.5(6.0, 15.0)]was statistically significantly lower than that of the NC group[28.0(27.0, 29.0)]( Z=-12.40, P<0.001), and the Activities of Daily Living(ADL)score of the DLB group[32.0(23.8, 40.0)]was statistically significantly higher than that of the NC group[20.0(20.0, 20.0)]( Z=-11.98, P<0.001).The scores of all MRI visual assessment scales in DLB patients were statistically significantly higher than those in the NC group( P<0.001).There were significant differences in MTA scores between DLB patients with different degrees of cognitive impairment( P0<0.001).The MTA score of the mild group[1.0(1.0, 1.0)]was statistically significantly lower than that of the moderate group[2.0(1.0, 2.0)]( P1<0.001, P2<0.001); The MTA score of the moderate group[2.0(1.0, 2.0)]was statistically significantly lower than that of the severe group[2.0(2.0, 3.0)]( P1=0.003, P2=0.010). Conclusions:This study has for the first time after comprehensively evaluated the value of various visual scores in DLB diagnosis, MTA can be used to help diagnose DLB and distinguish the severity of DLB, providing a new supplemental tool for clinical diagnosis.

Anosognosia in dementia with Lewy bodies: a systematic review / Anosognosia na demência com corpos de Lewy: uma revisão sistemática

ABSTRACT Background: Anosognosia, i.e. lack of awareness of one's own symptoms, is a very common finding in patients with dementia and is related to neuropsychiatric symptoms and worse prognosis. Although dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia, literature on anosognosia in this disease is scarce. Objectives: This paper aimed to review the current evidence on anosognosia in patients with DLB, including its prevalence in comparison with other neurological conditions, its severity and anatomical correlations. Methods: Database searches were performed in PubMed, Web of Knowledge and PsycINFO for articles assessing anosognosia in DLB. A total of 243 studies were retrieved, but only six were included in the review. Results: Potential risk of selection, comparison or outcome biases were detected in relation to all the studies selected. Most of the studies used self-report memory questionnaires to assess cognitive complaints and compared their results to scores from informant-based instruments or to participants' cognitive performance in neuropsychological tasks. Subjects with DLB had worse awareness regarding memory than healthy older controls, but the results concerning differences in anosognosia between DLB and Alzheimer's disease (AD) patients were inconsistent across studies. Presence of AD pathology and neuroimaging biomarkers appeared to increase the prevalence of anosognosia in individuals with DLB. Conclusion: Anosognosia is a common manifestation of DLB, but it is not clear how its prevalence and severity compare with AD. Co-existence of AD pathology seems to play a role in memory deficit awareness in DLB.

RESUMO Introdução: Anosognosia, i.e. a perda da consciência dos próprios sintomas, é um achado muito comum em pacientes com demência e está relacionada a sintomas neuropsiquiátricos e a pior prognóstico. Embora a doença por Corpos de Lewy (DCL) seja a segunda demência degenerativa mais comum, há pouca evidência sobre anosognosia nessa doença. Objetivos: Este artigo teve como objetivo revisar a evidência disponível sobre anosognosia em pacientes com DCL, incluindo sua prevalência em comparação a outras condições neurológicas, gravidade e correlações anatômicas. Métodos: Foram feitas buscas nos bancos de dados PubMed, Web of Knowledge e PsycINFO por artigos que avaliassem anosognosia na DCL. Um total de 243 estudos foi encontrado, mas apenas 6 foram incluídos nesta revisão. Resultados: Potenciais riscos de viés de seleção, comparação ou resultado foram encontrados em todos os estudos selecionados. A maior parte dos estudos utilizou questionários de memória preenchidos pelo próprio paciente e os comparou a resultados de instrumentos preenchidos por informantes ou à performance cognitiva em tarefas neuropsicológicas. Indivíduos com DCL têm pior consciencia de memória do que idosos saudáveis, mas os resultados tocantes à diferença de anosognosia entre DCL e doença de Alzheimer (DA) são inconsistentes entre estudos. A presença de achados patológicos e de neuroimagem de DA parece aumentar a prevalência de anosognosia entre pacientes com DCL. Conclusão: Anosognosia é uma manifestação comum da DCL, mas não é possível afirmar como sua prevalência e gravidade se comparam à DA. A coexistência de achados patológicos de DA parece influenciar a consciência de déficits de memória na DCL.

Active lifestyle enhances protein expression profile in subjects with Lewy body pathology / O estilo de vida ativo melhora o perfil de expressão de proteínas em indivíduos com a patologia de corpos de lewy

ABSTRACT. Clinical trials of the effects of physical activity have reported improvements in symptoms and quality of life in patients with Parkinson's disease (PD). Additionally, morphological brain changes after exercising were reported in PD animal models. However, these lifestyle-related changes were not evaluated in postmortem brain tissue. Objective: We aimed to evaluate, by immunohistochemistry, astrocytes, tyrosine hydroxylase (TH) and structural proteins expression (neurofilaments and microtubules — MAP2) changes in postmortem brain samples of individuals with Lewy body pathology. Methods: Braak PD stage≥III samples, classified by neuropathology analysis, from The Biobank for Aging Studies were classified into active (n=12) and non-active (n=12) groups, according to physical activity lifestyle, and paired by age, sex and Braak staging. Substantia nigra and basal ganglia were evaluated. Results: Groups were not different in terms of age or gender and had similar PD neuropathological burden (p=1.00). We observed higher TH expression in the active group in the substantia nigra and the basal ganglia (p=0.04). Astrocytes was greater in the non-active subjects in the midbrain (p=0.03) and basal ganglia (p=0.0004). MAP2 levels were higher for non-active participants in the basal ganglia (p=0.003) and similar between groups in the substantia nigra (p=0.46). Neurofilament levels for non-active participants were higher in the substantia nigra (p=0.006) but not in the basal ganglia (p=0.24). Conclusion: Active lifestyle seems to promote positive effects on brain by maintaining dopamine synthesis and structural protein expression in the nigrostriatal system and decrease astrogliosis in subjects with the same PD neuropathology burden.

RESUMO. Estudos dos efeitos da atividade física relataram melhora nos sintomas e na qualidade de vida de pacientes com doença de Parkinson (DP). Além disso, alterações morfológicas do cérebro após o exercício físico foram relatadas em modelos animais da DP. No entanto, essas mudanças relacionadas ao estilo de vida não foram avaliadas em tecido cerebral post-mortem. Objetivo: Avaliar a expressão de astrócitos, tirosina hidroxilase (TH) e a expressão de proteínas estruturais (neurofilamentos e microtúbulos — MAP2) por imuno-histoquímica, em amostras cerebrais post-mortem de indivíduos com corpos de Lewy. Métodos: Amostras com estágio de Braak para DP≥III, classificação neuropatológica, fornecidas pelo biobanco de estudos do envelhecimento foram classificadas em grupos ativos (n=12) e não ativos (n=12), de acordo com o estilo de vida (atividade física), e pareados por idade, sexo e estadiamento de Braak. Analisou-se a substância negra e gânglios da base. Resultados: Idade, sexo e classificação para DP foram semelhantes (p=1,00). Observou-se maior expressão de TH no grupo ativo (p=0,04). Amostras de não ativos revelaram maior expressão de astrócitos no mesencéfalo (p=0,03) e nos gânglios da base (p=0,0004); MAP2 nos gânglios da base (p=0,003); os níveis de neurofilamentos foram maiores na substância negra (p=0,006). Conclusão: O estilo de vida ativo parece promover efeitos positivos no cérebro, mantendo a síntese de dopamina e a expressão estrutural de proteínas no sistema nigrostriatal e com diminuição da ativação de astrócitos em indivíduos com a mesma classificação neuropatológica para a DP.

Correlates of neuropsychiatric and motor tests with language assessment in patients with Lewy body dementia

Abstract Background Lewy body dementia (LBD) impairs performance in daily activities and affects motor, language and visuospatial tasks. Objective We aimed to correlate neuropsychiatric and motor assessments with language and visual organization tests in LBD. Methods Twenty-two patients with dementia with Lewy bodies and ten patients with Parkinson's disease dementia participated on a cross-sectional study that assessed cognition, functionality, caregiver burden, verbal fluency, the primer-level dictation section of the Boston Diagnostic Aphasia Examination (PLD-BDAE), the Hooper Visual Organization Test, the Neuropsychiatric Inventory and the Movement Disorder Society - Unified Parkinson's Disease Rating Scale. Results Language and visuospatial test results followed motor impairment and general cognitive performance. Whereas visual organization did not predict performance in the PLD-BDAE, visuospatial abilities and verbal fluency were concurrently associated, suggesting that linguistic impairment in LBD may be attributed to neuropsychological components of cognition and language. Only visual organization was associated with behaviour, suggesting that neuropsychiatric symptoms associate with differential impairment of visual organization in comparison with language in LBD. Schooling did not affect visual organization or language test performance, while the length of dementia was negatively associated with visual organization and verbal fluency. Discussion Though visual organization tests follow behaviour and motor performance in LBD, there is differential impairment regarding language skills.

Ekbom Syndrome associated with Lewy Body Dementia: A case report / Síndrome de ekbom associada à demência com corpos de lewy: um relato de caso

ABSTRACT Ekbom Syndrome, also known as parasitosis delusion or psychogenic parasitosis, is a rare condition in which patients present with a fixed belief of being infested by parasites, vermin or small insects, along with tactile hallucinations (such as pruritus or sensations of the parasites crawling over or under the skin). The syndrome may occur idiopathically or be associated with other medical conditions and drug use. This case report describes the occurrence of Ekbom syndrome in a patient diagnosed with Lewy Body Dementia (LBD), a neurodegenerative disease that commonly presents with sensory perception and thought disorders and other neuropsychiatric symptoms. Although visual hallucination is considered a core diagnostic criterion, other modalities of psychiatric symptoms can also occur posing a further challenge for correct diagnosis. Proper recognition allows early diagnosis and adequate treatment, preventing hazardous antipsychotic use in these patients.

RESUMO A síndrome de Ekbom, também conhecida como delírio parasitário ou parasitose psicogênica, é uma condição rara na qual os pacientes apresentam crença fixa de estarem infestados por parasitas, vermes ou insetos, acompanhada de alucinações táteis (como prurido ou sensação dos parasitas andando sobre ou sob a pele). A síndrome pode ocorrer de forma idiopática ou associada a outras condições médicas ou uso de drogas. Este relato de caso descreve a ocorrência da síndrome de Ekbom em um paciente diagnosticado com Demência com corpos de Lewy (DCL), uma doença degenerativa que comumente se apresenta com desordens de sensopercepção e pensamento, e outros sintomas neuropsiquiátricos. A alucinação visual é considerada um dos critérios diagnósticos nucleares, entretanto outras modalidades de sintomas psiquiátricos podem ocorrer criando desafios adicionais ao diagnóstico correto. O reconhecimento apropriado permite o diagnóstico precoce e tratamento adequado, prevenindo o uso arriscado de antipsicóticos nesses pacientes.

An Evaluation of Community Pharmacists' Knowledge and Experience regarding Dementia with Lewy Bodies: / 医薬品情報学

Objective: Owing to inconspicuous memory impairment during early disease stage, patients with dementia with Lewy bodies (DLB) are often diagnosed with mental disorders according to depressive symptoms and visual hallucinations. Severe sensitivity to antipsychotic agents, a DLB characteristic, increases mortality. Herein, we reviewed current challenges and approaches for early DLB detection and appropriate drug use by evaluating pharmacists' ability to recognition of DLB and their level of involvement in medication consultation with dementia patients.Designs: This is a cross-sectional study in Japan.Methods: We provided an anonymous self-administered survey questionnaire to 372 community pharmacists. Descriptive statistics,chi-square test (attributes, recognition, and experiences with medication consultation), and content analysis (free description of drug hypersensitivity) were used for data analysis.Results: The recognition rates for questions on DLB symptoms were as follows: visual hallucinations, 76%; delusion, 63%; other symptoms, including those categorized as core clinical features, such as fluctuating cognition, and REM sleep behavior disorder,＜40%. The rate of other symptoms was similar to that of false recognition of Alzheimer's disease symptoms. The recognition rate of certain DLB symptoms varied depending on pharmacists' experience in medication consultation with dementia patients and drug-induced evaluation during delirium/cognitive decline over the previous month. Approximately 65% of the participants did not respond to open questions on symptoms suggestive of drug hypersensitivity, whereas 55% of those who responded referred to allergic symptoms such as rashes.Conclusion: Owing to their lack of recognition of DLB symptoms, the current contribution of pharmacists to early DLB detection and proper drug use is limited. Thus, it is important to provide patients' observation points and method of questioning during interviews so that pharmacists can easily recognize DLB symptoms. It is critical to clarify that DLB drug hypersensitivity is attributed to mechanisms different from that of drug allergy.

Investigation of the frequency and location of cerebral microbleeds in dementia with Lewy bodies versus in Alzheimer's disease / 中华老年医学杂志

Objective To investigate the frequency and location of cerebral microbleeds(CMB) in dementia with Lewy bodies(DLB)versus in Alzheimer's disease(AD).Methods This retrospective study included three groups of probable AD patients (n =156),dementia with Lewy bodies (n =67) and normal controls(n=172).Frequencies and location of CMBs in the three groups were calculated and recorded.The foci of MRI signal for CMB were confirmed by two radiologists at moments of unknowingness about diagnosis.The correlations of cerebral small vessel disease and cerebral amyloid angiopathy with the development of cognitive decline in AD were analyzed.Results The incidence rate of CMBs was higher in patients with groups of DLB(22.4 ％,15/67) and AD(19.8 ％,31/156) than in normal controls (8.2 ％,14/172) (P =0.002 and 0.002),while there was no significant difference in incidence rate of CMBs between DLB and AD groups(P＞0.05).The MRI signal intensity of CMBs was the highest in the occipital lobe of the DLB group,and was higher in the deep temporal lobe or temporal lobe in the AD group.Conclusions The frequency of CMB is higher in patients with DLB or AD than in normal controls and there is no significant difference in frequency of CMB between DLB and AD groups,which suggests that the pathophysiological mechanisms of CMB may be similar between AD and DLB.

Diagnosis and Clinical Progress in a Case of Dementia with Lewy Bodies / 생물치료정신의학

Dementia with Lewy bodies(DLB) is the second most common neurodegenerative disease. However, DLB might not be adequately diagnosed due to its variety of clinical symptoms. The authors present 65-year-old Mrs. A. who showed Parkinson's movement, cognitive decline, psychological symptoms, and autonomic dysfunction. According to the clinical features and biological markers in the recently revised DLB criteria, Mrs. A. was diagnosed with probable DLB. Differential diagnoses of delirium, Parkinson's dementia, and Alzheimer's dementia were discussed. Psychopharmacological treatments of antidepressants or anxiolytics caused intolerable side effects and showed little efficacy to Mrs. A. She experienced two episodes of hyponatremia during her one-year treatment. Recovery from neurological symptoms due to the first hyponatremia was time-consuming, and in the second, it was associated with changes in the level of consciousness despite relatively mild hyponatremia. A fall that occurred in the latter part of treatment triggered remarkable deterioration of DLB symptoms and daily life function. Prevention of falls is important for maintaining the quality of life of patients with DLB.

Demencia Por Cuerpos De Lewy, Un Reto Diagnóstico / Dementia With Lewy Bodies, A Diagnostic Challenge

Resumen La Demencia por cuerpos de Lewy es una enfermedad neurodegenerativa de etiología desconocida, corresponde a la segunda causa de demencia a partir de la sexta década de vida; su diagnóstico es un reto, debido a que ciertos de los signos y síntomas que presenta son típicos de la Enfermedad de Parkinson y la Enfermedad de Alzheimer. El siguiente reporte de caso es de los primeros en documentar un paciente con Demencia por cuerpos de Lewy en el Ecuador. Se expone un caso con Demencia por cuerpos de Lewy con el fin de plasmar la dificultad diagnóstica que genera esta patología y describir las características principales que la diferencian de otros síndromes demenciales, destacadas en los criterios recientemente actualizados por el Consorcio de Demencia por Cuerpos de Lewy. Un meticuloso examen neurológico y valoración neuropsicológica fueron ejes en el estudio y pronóstico del paciente que presentamos. La Demencia por cuerpos de Lewy requiere un diagnóstico minucioso, debido al desafío que origina su reconocimiento precoz; los criterios descritos aceleraron su reconocimiento gracias a la actualización de las recomendaciones sobre el diagnóstico clínico de Demencia por cuerpos de Lewy.

Abstract Dementia with Lewy bodies is a neurodegenerative disease of unknown etiology, it is the second cause of dementia of the sixth decade of life; Its diagnosis is a challenge, because certain signs and symptoms that it presents are typical of Parkinson's Disease and Alzheimer's Disease. The following case report is one of the few documented patients with Dementia with Lewy bodies in Ecuador. We report this in order to state the diagnostic difficulty that this pathology generates and describe the main characteristics that differentiate it from other dementia syndromes, highlighted in the recently updated criteria by the Consortium of Dementia with Lewy bodies. A meticulous neurological examination and neuropsychological assessment were essential in the study and prognosis of the patient. Dementia with Lewy bodies requires a thorough diagnosis, due to the challenge that originates its early recognition; the criteria described accelerated their recognition due the update of the recommendations on the clinical diagnosis of Dementia with Lewy bodies.

Neural structural imaging in the assessment of cognitive impairment / 医学研究生学报

As our country steps into the aging society gradually, the number of cognitive impairments and the prevalence rate are increasing yearly. The family and society bear a heavy burden. It is more important to explore the more direct and Objective morphological changes of cognitive impairment through neural structural imaging , which is better for early diagnosis, intervention and delay or even prevent its progress. Here we present a review of this topic focusing on neural structural imaging in the assessment of cognitive impairment.

Heart rate variability and its influencing factors in patients with dementia with Lewy bodies and patients with Parkinson disease dementia / 中华老年医学杂志

Objective To compare the difference in heart rate variability (HRV)between patients with dementia with Lewy bodies(DLB)and those with Parkinson disease dementia(PDD)and to identify the influencing factors.Methods We retrospectively enrolled 30 patients with DLB(DLB group)and 41 patients with PDD(PDD group)at the outpatient and inpatient services of our hospital from January 2010 to December 2017 in this study,and further recruited 119 normal elderly individuals to serve as the control group.HRV was recorded with 24 h dynamic electrocardiogram and compared between the DLB group and the PDD group.Time domain measures including standard deviation of all normal to normal(NN)intervals(SDNN)and square root of the mean squared differences of successive N N intervals(rMSSD)and frequency domain measures including total power(TP),low frequency(LF),and high frequency(HF)were analyzed with a customized program.The levodopa equivalent dose (LED),mini-mental state examination (MMSE),Montreal Cognitive Assessment (MoCA),Hoehn-Yahr stage(H-Y stage)and the unified Parkinson's disease rating scale Ⅲ (UPDRS Ⅲ),and the Alzheimer's disease Cooperative Study-Activities of Daily Living scale(ADCS-ADL)were assessed in DLB and PDD patients to investigate the influencing factors.Results SDNN,TP,and LF in the DLB group and the PDD group were significantly lower than in the control group (F =14.154,4.742,4.897,P＜0.05).Compared with the control group,rMSSD decreased in the DLB group,but had no significant difference in the PDD group(P＞0.05).The DLB group and the PDD group did not differ in HF from the control group (P ＞ 0.05).There was no significant difference in any HRV indexes between DLB and PDD patients(P ＞0.05).Correlation analysis showed no correlation of HRV with cognitive level(MMSE,MoCA),motor disturbance degree (UPDRS Ⅲ,H-Yahr stage),daily living ability(ADCS-ADL),or dosage of anti-PD drugs (each P ＞ 0.05).Conclusions DLB and PDD patients present similar impairments in autonomic nervous system function,which are not associated with disease severity.

A comparative analysis of clinical manifestations of Alzheimer's disease patients and Lewy body dementia patients / 中华老年医学杂志

Objective To compare cognitive ,behavioral ,and psychological symptoms observed in Alzheimer's disease (AD ) and dementia with Lewy body (DLB ) in order to provide helpful information for differential diagnosis. Methods We selected 215 patients with AD (AD group)and 66 patients with DLB(DLB group)to retrospectively analyzed their general information ,family history , and disease history.The Mini-Mental State Examination(MMSE scale)was used to evaluate cognitive abilities and Neuropsychiatric Inventory ( NPI scale ) was used for analysis of behavioral and psychological symptoms of dementia in both groups. Results The prevalence of hypertension was higher in the AD group(52.6%,n＝113)than in the DLB group(40%,n＝24)(P＜0.05).The DLB group showed better general cognitive scores ,disorientation scores ,immediate recall scores ,and delayed recall scores than the AD group. Fluctuating cognitive deficiencies and Parkinson's symptoms were more prevalent in the DLB group than in the AD group with 2 patients (0.9%) showing fluctuating cognitive deficiencies in the AD group ,and 19(28.8%)in the DLB group(χ2＝8.580 ,P＝0.003) ;with 26 patients(12.1%)showing Parkinson's symptoms in the AD group and 25(37.9%)in the DLB group(χ2＝ 22.602 ,P＝ 0.000).As to behavioral and psychological symptoms ,the DLB group had higher scores in total NPI ,hallucinations and nighttime abnormal behaviors with 32 patients (14.9%)showing hallucinations and 64 (29.8%)showing nighttime abnormal behaviors in the AD group ;30(46.2%)showing hallucinations and 30 (46.2%)showing nighttime abnormal behaviors in the DLB group (all P ＜ 0.05 ) . Conclusions Hypertension is more prevalent in AD patients. Fluctuating cognitive deficiencies ,Parkinson's symptoms ,hallucinations ,and nighttime abnormal behaviors are prominent manifestations in DLB patients.

Relationships between Rapid Eye Movement Sleep Behavior Disorder and Neurodegenerative Diseases: Clinical Assessments, Biomarkers, and Treatment / 中华医学杂志(英文版)

<p><b>Objective</b>Rapid eye movement sleep behavior disorder (RBD) is characterized by dream enactment and loss of muscle atonia during rapid eye movement sleep. RBD is closely related to α-synucleinopathies including Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. Many studies have investigated the markers of imaging and neurophysiological, genetic, cognitive, autonomic function of RBD and their predictive value for neurodegenerative diseases. This report reviewed the progress of these studies and discussed their limitations and future research directions.</p><p><b>Data Sources</b>Using the combined keywords: "RBD", "neurodegenerative disease", "Parkinson disease", and "magnetic resonance imaging", the PubMed/MEDLINE literature search was conducted up to January 1, 2018.</p><p><b>Study Selection</b>A total of 150 published articles were initially identified citations. Of the 150 articles, 92 articles were selected after further detailed review. This study referred to all the important English literature in full.</p><p><b>Results</b>Single-nucleotide polymorphisms in SCARB2 (rs6812193) and MAPT (rs12185268) were significantly associated with RBD. The olfactory loss, autonomic dysfunction, marked electroencephalogram slowing during both wakefulness and rapid eye movement sleep, and cognitive impairments were potential predictive markers for RBD conversion to neurodegenerative diseases. Traditional structural imaging studies reported relatively inconsistent results, whereas reduced functional connectivity between the left putamen and substantia nigra and dopamine transporter uptake demonstrated by functional imaging techniques were relatively consistent findings.</p><p><b>Conclusions</b>More longitudinal studies should be conducted to evaluate the predictive value of biomarkers of RBD. Moreover, because the glucose and dopamine metabolisms are not specific for assessing cognitive cognition, the molecular metabolism directly related to cognition should be investigated. There is a need for more treatment trials to determine the effectiveness of interventions of RBD on preventing the conversion to neurodegenerative diseases.</p>

Characteristics of facial expression recognition ability in patients with Lewy body disease

BACKGROUND@#The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated.@*METHODS@#During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of "happiness," "sadness," "fear," "anger," "surprise," and "disgust" for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type.@*RESULTS@#In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: "stable type," "mixed type," and "reduced type". In the "reduced type", the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined.@*CONCLUSION@#There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.

Lafora and Trétiakoff: the naming of the inclusion bodies discovered by Lewy / Lafora e Trétiakoff: a denominação dos corpos de inclusão descobertos por Lewy

ABSTRACT Fritz Heinrich Jakob Lewy described, for the first time, in 1912, novel peculiar inclusions in neurons of certain brain nuclei in patients with Paralysis agitans, and compared his finding to the amyloid bodies described by Lafora one year before. Gonzalo Rodriguez Lafora studied one patient with Paralysis agitans, in 1913, and recognized, described, and depicted structures identical to those previously reported by Lewy. He was the first to acknowledge Lewy's finding, and also the first to name such inclusions after the discoverer - cuerpos intracelulares de Lewy (Lewy bodies). Konstantin Nikolaevich Trétiakoff named the inclusions he found in neurons of the substantia nigra of patients with Parkinson's disease as corps de Lewy (Lewy bodies), in 1919. Trétiakoff has unanimously received the credit for the eponym. However, Lafora's earlier description should make him deserving of the authorship of the eponym.

RESUMO Fritz Heinrich Jakob Lewy descreveu pela primeira vez, em 1912, inclusões singulares inéditas em neurônios de certos núcleos do cérebro em casos de Paralysis agitans e comparou seu achado aos corpos amilóides, como descrito por Lafora um ano antes. Gonzalo Rodriguez Lafora estudou um caso de Paralysis agitans, em 1913,e reconheceu, descreveu e representou estruturas idênticas às recentemente relatadas por Lewy. Foi o primeiro a reconhecer o achado de Lewy e também o primeiro a denominar tais inclusões segundo seu descobridor - cuerpos intracelulares de Lewy (corpos de Lewy). Konstantin Nikolaevich Tretiakoff designou as inclusões que encontrou em neurônios da substantia nigra em casos de doença de Parkinson de corps de Lewy (corpos de Lewy), em 1919. Ele recebeu o crédito pelo epônimo de modo unânime. Entretanto, a descrição anterior de Lafora deveria fazê-lo merecedor da autoria do epônimo.