루이소체 치매 1례의 진단 및 임상경과
Diagnosis and Clinical Progress in a Case of Dementia with Lewy Bodies
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Dementia with Lewy bodies(DLB) is the second most common neurodegenerative disease. However, DLB might not be adequately diagnosed due to its variety of clinical symptoms. The authors present 65-year-old Mrs. A. who showed Parkinson’s movement, cognitive decline, psychological symptoms, and autonomic dysfunction. According to the clinical features and biological markers in the recently revised DLB criteria, Mrs. A. was diagnosed with probable DLB. Differential diagnoses of delirium, Parkinson’s dementia, and Alzheimer’s dementia were discussed. Psychopharmacological treatments of antidepressants or anxiolytics caused intolerable side effects and showed little efficacy to Mrs. A. She experienced two episodes of hyponatremia during her one-year treatment. Recovery from neurological symptoms due to the first hyponatremia was time-consuming, and in the second, it was associated with changes in the level of consciousness despite relatively mild hyponatremia. A fall that occurred in the latter part of treatment triggered remarkable deterioration of DLB symptoms and daily life function. Prevention of falls is important for maintaining the quality of life of patients with DLB.
Abstract
Dementia with Lewy bodies(DLB) is the second most common neurodegenerative disease. However, DLB might not be adequately diagnosed due to its variety of clinical symptoms. The authors present 65-year-old Mrs. A. who showed Parkinson’s movement, cognitive decline, psychological symptoms, and autonomic dysfunction. According to the clinical features and biological markers in the recently revised DLB criteria, Mrs. A. was diagnosed with probable DLB. Differential diagnoses of delirium, Parkinson’s dementia, and Alzheimer’s dementia were discussed. Psychopharmacological treatments of antidepressants or anxiolytics caused intolerable side effects and showed little efficacy to Mrs. A. She experienced two episodes of hyponatremia during her one-year treatment. Recovery from neurological symptoms due to the first hyponatremia was time-consuming, and in the second, it was associated with changes in the level of consciousness despite relatively mild hyponatremia. A fall that occurred in the latter part of treatment triggered remarkable deterioration of DLB symptoms and daily life function. Prevention of falls is important for maintaining the quality of life of patients with DLB.
참고문헌 (22)
- 김태희, "루이소체 치매의 증상과 치료", 생물정신의학, 23(2), pp.41~47 (2016), 대한생물정신의학회
- McKeith IG, "Diagnosis and management of dementia with Lewy bodies : Fourth consensus report of the DLB Consortium", Neurology, 89, pp.88~100 (2017)
- Gore RL, "Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?", J Neurol Neurosurg Psychiatry, 86, pp.50~59 (2015)
- Coon EA, "Neuropathology of autonomic dysfunction in synucleinopathies", Mov Disord, 33, pp.349~358 (2018)
- Jicha GA, "Prodromal clinical manifestations of neuropathologically confirmed Lewy body disease", Neurobiol Aging, 31, pp.1805~1813 (2010)
- Borroni B, "Behavioral and psychological symptoms in dementia with Lewy-bodies(DLB) : frequency and relationship with disease severity and motor impairment", Arch Gerontol Geriatr, 46, pp.101~106 (2008)
- Mochizuki H, "A refined concept : α-synuclein dysregulation disease", Neurochem Int, 119, pp.84~96 (2018)
- McKeith IG, "Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies(DLB) : report of the consortium on DLB international workshop", Neurology, 47, pp.1113~1124 (1996)
- McKeith IG, "Diagnosis and management of dementia with Lewy bodies : third report of the DLB Consortium", Neurology, 65, pp.1863~1872 (2005)
- Kaufmann H, "Autonomic failure in neurodegenerative disorders", Semin Neurol, 23, pp.351~363 (2003)
- Spillantini MG, "The alpha-synucleinopathies:Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy", Ann N Y Acad Sci, 920, pp.16~27 (2000)
- Mueller C, "The prognosis of dementia with Lewy bodies", Lancet Neurol, 16, pp.390~398 (2017)
- Kitajima Y, "A review of the role of anticholinergic activity in Lewy body disease and delirium", Neurodegener Dis, 15, pp.162~167 (2015)
- Blanc F, "Prodromal stage of disease(dementia)with Lewy bodies, how to diagnose in practice?", Geriatr Psychol Neuropsychiatr Vieil, 15, pp.196~204 (2017)
- Peraza LR, "Resting state in Parkinson’s disease dementia and dementia with Lewy bodies : commonalities and differences", Int J Geriatr Psychiatry, 30, pp.1135~1146 (2015)
- Postuma RB, "MDS clinical diagnostic criteria for Parkinson’s disease", Mov Disord, 30, pp.1591~1601 (2015)
- Hori K, "Anticholinergic activity and Alzheimer’s disease", Neurodegener Dis, 15, pp.131~133 (2015)
- Blanc F, "Grey matter atrophy in prodromal stage of dementia with Lewy bodies and Alzheimer’s disease", Alzheimers Res Ther, 8, pp.31~ (2016)
- Schnitzler A, "Neurophysiology and functional neuroanatomy of pain perception", J Clin Neurophysiol, 17, pp.592~603 (2000)
- Egger C, "A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine", Int J Psychiatry Clin Pract, 10, pp.17~26 (2006)
- Verbalis JG, "Brain volume regulation in response to changes in osmolality", Neuroscience, 168, pp.862~870 (2010)
- Choi Y, "Syndrome of inappropriate antidiuretic hormone secretion associated with pramipexole in a patient with Parkinson’s disease", J Mov Disord, 4, pp.46~48 (2011)