2009 Spring Geriatric Mental Health & Aging Conference ARIZONA GERIATRICS SOCIETY. Partner & Owner Well Being Systems
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1 LEWY BODY DEMENTIA Alvin Burstein, MD Partner & Owner Well Being Systems Objectives: Explain the classic triad of Lewy Body Dementia Describe the common clues from a patient's history Describe the neurochemistry and predict what will improve and worsen the clinical picture DISCLOSURE OF COMMERCIAL SUPPORT Alvin Burstein, MD does have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. AstraZeneca, Eli Lilly, Forest, GlaxoSmithKline, Novartis, Pfizer, Takeda, Wyeth 2009 All Rights Reserved 11
2 Slide 1 Slide 2 Lewy Body Dementia Alvin C. Burstein, MD Well Being Systems, PLLC Adjunct Associate Professor Psychiatry, Midwestern Medical College Slide 3 Lewy Body Dementia History of the diagnosis How common is it? What is the neuropathology? How to recognize it How to treat it 2009 All Rights Reserved 12
3 Slide 4 History Frederick Lewy. Parkinson s s disease cortical Lewy Bodies discovered modern staining Slide 5 FREQUENCY OF TYPES OF DEMENTIA Florida State Brain Bank Alzheimer s s Disease 77% Lewy Body Dementia 26% Vascular Dementia 18% Hippocampal Sclerosis 13% Frontotemporal Dementia 5% Barker, et. al., Alzheimer Disease and Related Disorders, 10/02 Slide 6 Neuropathology 2009 All Rights Reserved 13
4 Slide 7 Normal Brain Slide 8 Lewy Body Dementia Brain Slide 9 Lewy Body Alpha-Synuclein 2009 All Rights Reserved 14
5 2009 Spring Geriatric Mental Health & Aging Conference Slide 10 Cholinergic Pathways From the Basal Forebrain ARIZONA GERIATRICS SOCIETY PC FC BF H O C Cummings JL. Am J Psychiatry. 2000;157:4-15. Slide 11 Slide 12 Lewy Body DementiaHow to recognize it 2009 All Rights Reserved 15
6 Slide 13 Lewy Body Dementia- How to recognize it Classic Triad Parkinsonian gait Fluctuating alertness/mse Psychiatric symptoms Slide 14 Lewy Body Dementia- How to recognize it earliest signs Sleep disturbance Loss of smell Medication reactions Slide 15 Lewy Body Dementia- How to recognize it Associated Symptoms Abnormal response to medications Autonomic instability Falls Visuospatial deficits 2009 All Rights Reserved 16
7 Slide 16 Lewy Body Dementia Case studies Slide 17 ADMISSION HISTORY DOROTHY S S STORY Slide 18 TYPICAL STORY WE CAN T T HANDLE HER THANK GOD FOR THE ATIVAN, IT S S THE ONLY THING THAT WORKS WHENEVER SHE WAKES UP, SHE IS UNPREDICTABLE. SHE FALLS, SHE HITS PEOPLE SHE SEES THINGS SHE RESISTS ALL CAREGIVER HELP SHE S S GETTING WORSE 2009 All Rights Reserved 17
8 Slide 19 What does Lewy Body Dementia look like? Slide 20 What does Lewy Body Dementia look like? Slide 21 BILL S S STORY 2 Year history of memory problems Diagnosed with Parkinson s s Disease and Alzheimer s s at the same time Seems to have gone down hill so quickly He picks at things that are not there His violence has become unmanageable 2009 All Rights Reserved 18
9 Slide 22 BILL Slide 23 Slide 24 Non-medical Treatments 2009 All Rights Reserved 19
10 Slide 25 What to avoid: Treatments, Medications Slide 26 What helps: Treatments, Medications Slide 27 Summary 2009 All Rights Reserved 20
11 Slide 28 FDA Warning Slide 29 Thank you for your attention QUESTIONS? 2009 All Rights Reserved 21
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