Relevance of subcortical visual pathways disruption to visual symptoms in dementia with Lewy bodies

A 61-year old engineer was referred for a fourth opinion regarding visual symptoms. He had a recent history of depression, and was taking fluoxetine. He reported an eight-year history of progressive visual symptoms, manifest particularly as difficulty judging distances and depth. He acknowledged visual misperceptions and rare visual hallucinations; his reading had deteriorated; he complained of loss of mathematical skills. There had been episodic topographical disorientation. Memory and insight were preserved. There were no extrapyramidal symptoms. Examination (see video) revealed evidence of significant parietal and some frontal dysfunction. Visuospatial and visuoperceptual impairments were particularly marked. There was no evidence of parkinsonism. A diagnosis of posterior cortical atrophy (PCA) syndrome was made. Structural imaging was reported as normal but SPECT imaging revealed bilateral presynaptic dopaminergic denervation and FDG-PET demonstrated significant parieto-occipital hypometabolism. CSF tau and beta-amyloid levels were normal. A diagnosis of probable dementia with Lewy bodies (DLB) was made. PCA is a relatively rare and often under-recognised neurodegenerative syndrome, most frequently associated with Alzheimer pathology. The clinical and paraclinical findings in this case suggest a Lewy body process, which very rarely presents as PCA. The challenges pertaining to the accurate diagnosis of PCA and the implications for management are discussed.

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Supplemental Material for Visuospatial Deficits Predict Rate of Cognitive Decline in Autopsy-Verified Dementia With Lewy Bodies

Neuropsychology ◽

10.1037/a0012949.supp ◽

2008 ◽

Keyword(s):

Cognitive Decline ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Visuospatial Deficits

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Differences in glucose metabolism between dementia with Lewy bodies and dementia associated with Parkinson's disease

Aktuelle Neurologie ◽

10.1055/s-2005-919519 ◽

2005 ◽

Vol 32 (S 4) ◽

Author(s):

P Häussermann ◽

A.O Ceballos-Baumann ◽

H Förstl ◽

R Feurer ◽

B Conrad ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Glucose Metabolism ◽

Dementia With Lewy Bodies ◽

Lewy Bodies

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Visual Hallucinations and Dementia With Lewy Bodies

Archives of Neurology ◽

10.1001/archneur.57.12.1792 ◽

2000 ◽

Vol 57 (12) ◽

pp. 1792-1792 ◽

Cited By ~ 3

Author(s):

M. Serby

Keyword(s):

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Visual Hallucinations

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Dementia with Lewy bodies

V M BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY ◽

10.31363/2313-7053-2018-2-11-21 ◽

2018 ◽

pp. 11-21

Author(s):

O. S. Levin ◽

E. E. Vasenina ◽

A. Sh. Chimagomedova ◽

N. G. Dudchenko

Keyword(s):

Parkinson’S Disease ◽

Dementia With Lewy Bodies ◽

Cholinesterase Inhibitors ◽

Lewy Bodies ◽

Diagnosis And Treatment ◽

Modern Concept ◽

Historical Aspect ◽

Neurodegenerative Process ◽

Icd 10

Te lecture presents modern concept of the symptoms, diagnosis and treatment of dementia with Lewy bodies (DLB), which accounts for about 10% of cases of dementia. Te nosological status of DLB and the problem of ratio of DLB and Parkinson’s disease which, apparently, represent two phenotypic variants of one neurodegenerative process («diseases with Lewy bodies») are considered in historical aspect. Approaches to the diagnosis and coding of DLB in accordance with ICD-10 are proposed. Te role of cholinesterase inhibitors, antipsychotics, levodopa, rasagiline and other drugs in the treatment of patients with DLB is аnalyzed.

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