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Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

Lookup NU author(s): Dr Rachel Gore, Dr Emma Vardy, Professor John O'Brien

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Abstract

Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk.

Publication metadata

Author(s): Gore RL, Vardy ERLC, O'Brien JT

Publication type: Article

Publication status: Published

Journal: Journal of Neurology, Neurosurgery & Psychiatry

Year: 2015

Volume: 86

Issue: 1

Pages: 50-59

Print publication date: 01/01/2015

Online publication date: 23/05/2014

Acceptance date: 23/04/2014

ISSN (print): 0022-3050

ISSN (electronic): 1468-330X

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/jnnp-2013-306389

DOI: 10.1136/jnnp-2013-306389

PubMed id: 24860139

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