Neurology® Podcast Dementia with Lewy Bodies and Parkinson Disease Dementia
Nov 20, 2025
Dr. YuHong Fu, a neuroscientist from the University of Sydney, dives into the critical distinctions between dementia with Lewy bodies and Parkinson disease dementia. She highlights the unique clinical symptoms, such as fluctuating attention and hallucinations in DLB. Fu discusses how understanding these differences not only aids in diagnosis but also influences treatment strategies. She touches on biomarkers like DaT scans and emerging assays, emphasizing their roles in tailoring personalized care for patients.
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Timing Versus Biology Matters
- Clinically, dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD) are separated by timing of cognitive symptoms relative to motor onset.
- Biologically they share alpha-synuclein pathology but take different anatomical routes and co-pathology, so the distinction matters.
Distinct Clinical Presentations
- DLB often shows early fluctuating attention, visuospatial deficits, vivid visual hallucinations, and neuroleptic sensitivity before motor signs.
- PDD tends to have earlier motor signs with slower, steadier cognitive decline progressing later to dementia.
Different Pathology Patterns
- Both disorders share Lewy pathology but distribution differs: DLB shows widespread cortical Lewy bodies and more amyloid; PDD starts in brainstem and later reaches cortex with less amyloid.
- Vascular copathology and white matter changes are more common in DLB and may explain delirium-like episodes.