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Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?
  1. Rachel L Gore1,2,
  2. Emma R L C Vardy1,3,
  3. John T O'Brien1,4
  1. 1Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
  2. 2Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Trust, Morpeth, Northumberland, UK
  3. 3Department of Older Peoples Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
  4. 4Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Level E4 Cambridge Biomedical Campus, Cambridge, UK
  1. Correspondence to Professor John T O'Brien, Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK; john.obrien{at}medschl.cam.ac.uk

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.

Keywords
  • Delirium
  • DLB
  • Pathophysiology
  • Neuroimaging
  • Biomarkers

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