Changes associated with DLB include preservation of hippocampal and medial temporal lobe volume on magnetic resonance imaging

(MRI)35,36 and occipital hypoperfusion on single-photon emission computed tomography (SPECT).37,38 Other features, such as generalized atrophy,36 white matter changes,39 and rates of progression of whole brain atrophy,40 appear to be unhelpful in differential diagnosis. Dopamine transporter loss in the caudate and putamen, a marker of nigrostriatal degeneration can be detected by dopaminergic SPECT and, in preliminary studies, has shown specificity and sensitivity of 85% or higher, and may be particularly helpful.41,12 Fluctuating cognition The Inhibitors,research,lifescience,medical profile of neuropsychological impairments in patients with DLB differs from that of AD and other dementia syndromes,43 reflecting the combined involvement of cortical and subcortical pathways and relative sparing of

the hippocampus. Patients with DLB Inhibitors,research,lifescience,medical perform better than AD on tests of verbal memory,44 but worse on visuospatial performance tasks45 and tests of attention.46 Fluctuations in cognitive function, which may vary over minutes, hours, or days, occur in 50% to 75% of patients, and are associated with shifting levels of attention and alertness. The assessment of fluctuating cognitive impairment Inhibitors,research,lifescience,medical poses considerable difficulty to most clinicians and has been repeatedly Inhibitors,research,lifescience,medical cited as a reason for low clinical ascertainment of DLB.31,47 Newly proposed www.selleckchem.com/products/Perifosine.html methods of assessment may be particularly helpful in this regard. These include caregiverand observer-rated scales.48 Questions such as whether there are episodes when the patient’s thinking seems quite clear and then becomes muddled may be useful probes,49,50 www.selleckchem.com/products/DAPT-GSI-IX.html although one recent study51 found carers’ reports of fluctuation to be less reliable

predictors of DI B diagnosis than more objective questions about daytime sleepiness, episodes of staring blankly, or incoherent speech (Table III). Recording variation in attentional Inhibitors,research,lifescience,medical performance using a computer-based test system52 offers an independent method of measuring fluctuation, which is also sensitive to drug treatment effects.53 Table III. Assessing cognitive fluctuation in dementia with Lewy bodies GSK-3 (DLB). AD, Alzheimer’s disease. Neuropsychiatrie features Although the expression “noncognitive features of dementia“ is frequently used to describe a multiplicity of symptoms such as apathy, anxiety, delusions, hallucinations, and depression that, are common in dementia, this term implies, probably incorrectly, that such features are independent of cognitive dysfunction. ”Neuropsychiatrie features“54 is a more useful epithet to describe such symptoms, which are particularly common in DLB and which often prompt, referral for clinical assessment. Visual hallucinations are the most, characteristic neuropsychiatrie feature of DLB, and it.