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Operational criteria for senile dementia of Lewy body type (SDLT)

Published online by Cambridge University Press:  09 July 2009

I. G. McKeith ,
R. H. Perry ,
A. F. Fairbairn ,
S. Jabeen  and
E. K. Perry
I. G. McKeith*
Affiliation:
University Department of Old Age Psychiatry, Brighton Clinic; Departments of Neuropathology and Pathology, MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle-upon-Tyne
R. H. Perry
Affiliation:
University Department of Old Age Psychiatry, Brighton Clinic; Departments of Neuropathology and Pathology, MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle-upon-Tyne
A. F. Fairbairn
Affiliation:
University Department of Old Age Psychiatry, Brighton Clinic; Departments of Neuropathology and Pathology, MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle-upon-Tyne
S. Jabeen
Affiliation:
University Department of Old Age Psychiatry, Brighton Clinic; Departments of Neuropathology and Pathology, MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle-upon-Tyne
E. K. Perry
Affiliation:
University Department of Old Age Psychiatry, Brighton Clinic; Departments of Neuropathology and Pathology, MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle-upon-Tyne
*
1 Address for correspondence: Dr I. G. McKeith, Brighton Clinic, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE.
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Synopsis

Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD.

Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%.

Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 4 , November 1992 , pp. 911 - 922
Copyright
Copyright © Cambridge University Press 1992

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