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Are Parkinson’s Disease with dementia and Dementia with lewy Bodies the Same Entity?

Centre for Neuro and Geriatric Psychiatric Research, Psychiatric Clinic, Rogaland Central Hospital, PO Box 1163, Hillevaag, 4095 Stavanger, Norwaydaa{at}sir.no

C. G. Ballard, MD, MRCPsych

Institute of Psychiatry, King’s College London, United Kingdom

Glenda Halliday, PhD

Prince of Wales Medical Research Institute and the University of New South Wales, Sydney, Australia

The diagnosis of Parkinson’s disease with dementia (PDD) or dementia with Lewy bodies (DLB) is based on an arbitary distinction between the time of onset of motor and cognitive symptoms. These syndromes share many neurobiological similarities, but there are also differences. Deposition of beta-amyloid protein is more marked and more closely related to cognitive impairment in DLB than PDD, possibly contributing to dementia at onset. The relatively more severe executive impairment in DLB than PDD may relate to the loss of frontohippocampal projections in DLB. Visual hallucinations and delusions associate with more abundant Lewy body pathology in temporal cortex in DLB. The differential involvement of pathology in the striatum may account for the differences in parkinsonism. Longitudinal studies with neuropathological and neurochemical evaluations will be essential to enable more robust comparisons and determine pathological substrates contributing to the differences in cognitive, motor, and psychiatric symptoms. (J Geriatr Psychiatry Neurol 2004; 17:137-145)

Key Words: cognition • dementia • Lewy bodies • neurochemistry • neuropathology • parkinsonism

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