Abstract Summary Differences and similarities between Lewy body dementia and Parkinson’s disease dementia
The diagnosis of Lewy body dementia (LBD) and Parkinson’s disease dementia (PDD) is based on an arbitrary distinction between the time of onset of cognitive and motor symptoms. Both diagnoses share many features, like the presence of Lewy bodies, the core symptomatology and the core neurochemical deficits.
However, the cognitive symptoms are more severe in DLB, very likely due to extensive beta-amyloid deposits in the cortex, the parkinsonian symptoms are more severe in PDD, due to the more extensive loss of presynaptic dopaminergic neurons and the hippocampal atrophy is more extensive in DLB, very likely due to a loss of fronto-hippocampal projections. Therefore DLB and PDD seem to be part of a spectrum of Lewy body pathologies, which may be accompanied by other protein deposits, like beta-amyloid, causing a different severity and timing of the symptoms. The cognitive symptoms and hallucinations can be treated by cholinesterase inhibitors and anti-psychotics. DLB patients mostly do not tolerate antipsychotics, causing extrapiramidal side effects.
Samenvatting
De diagnose Lewy body dementie (DLB) of Parkinson dementia (PDD) wordt gesteld op basis van een arbitrair onderscheid in tijdstip van ontstaan van de dementie en de motorische symptomen. Beide beelden hebben veel overeenkomsten, zoals het voorkomen van Lewy bodies, de identieke kernsymptomen, en de gemeenschappelijke neurochemische defecten.
Echter de dementie is meer uitgesproken bij DLB, waarschijnlijk door de uitgebreide aanwezigheid van beta-amyloid deposities in de cortex, het parkinsonisme is meer uitgesproken bij PDD door een uitgebreider pre-synaptisch dopaminerg neuronverlies en er wordt meer hippocampale atrofie gevonden bij DLB vs. PDD, o.a. op basis van een verlies aan hippocampale projecties naar de cortex. DLB en PDD kunnen daarom het beste beschouwd worden als 2 vormen binnen het spectrum van Lewy body beelden, al of niet in combinatie met andere eiwitstapelingen zoals beta-amyloid, die ernst en timing van symptomen variabel maken. De cognitieve klachten en hallucinaties bij DLB en PDD kunnen behandeld worden met cholinesterase remmers. Anti-psychotica zijn vooral geschikt voor PDD patienten, omdat DLB patienten hiervoor vaak overgevoelig zijn.
Trefwoorden: Lewy bodies (LB), Lewy body dementie (LBD), Parkinson dementie (PDD), dopamine, acetylcholine, cholinesterase remmers, anti-psychotica
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neuroloog Polikliniek Bewegingsstoornissen, UMC Groningen
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van Laar, T. Het spectrum van dementie met Lewy bodiesOver oorzaak, klinisch beeld en behandeling. TVVG 31, 71–75 (2006). https://doi.org/10.1007/BF03075148
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DOI: https://doi.org/10.1007/BF03075148