384 Ch 383. Dementia with Lewy Bodies (DLB) and Vascular Cognitive Impairment

DLB = 3rd most common dementia after AD + vascular; synucleinopathy；core features: (1) fluctuating cognition (alertness, attention), (2) visual hallucinations (well-formed, recurrent, often people/animals), (3) REM behavior disorder (RBD), (4) parkinsonism；supportive: severe sensitivity to antipsychotics + autonomic dysfunction + non-visual hallucinations + delusions + depression + apathy；vs PD dementia: timing of cognitive vs motor symptoms — DLB has cognitive within 1 year of parkinsonism (or before); PDD has motor > 1 year before cognitive；diagnosis: clinical + indicative biomarkers (DaT-SCAN abnormal + MIBG decreased + RBD on PSG); treatment: rivastigmine + donepezil (more responsive than AD), EXTREME CAUTION with antipsychotics (severe sensitivity, mortality) — pimavanserin or low-dose quetiapine/clozapine for psychosis; vascular cognitive impairment (VCI) = cognitive impairment from vascular disease — strokes, microvascular, mixed；spectrum from VaMCI to vascular dementia；diagnosis: cognitive deficit + vascular evidence + temporal/anatomic link；no specific DMT — manage vascular risk factors aggressively。