China
Africa
Explore chapters and articles related to this topic
The nervous system and the eye
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
James A.R. Nicoll, William Stewart, Fiona Roberts
In Parkinson's disease there is selective and progressive destruction of the pigmented neurons in the substantia nigra, accompanied by the deposition of granules of neuromelanin pigment. Residual pigmented neurons contain large intracytoplasmic inclusions known as Lewy bodies (Figure 12.40). In advanced cases, depigmentation of the substantia nigra is readily apparent macroscopically (Figure 12.40A). The neurons of the substantia nigra project to the corpus striatum (globus pallidus and putamen) where they release the neurotransmitter dopamine. Treatment with a dopamine precursor (L-dopa) may relieve the symptoms of the disease but does not slow the progress of the underlying neuronal degeneration. Most cases of Parkinson's disease occur sporadically but, rarely, it is inherited as an autosomal dominant trait with mutations in the PARK1 gene on chromosome 4 encoding α-synuclein, a component of Lewy bodies, among many other mutations that have been identified. There is a poorly understood overlap with dementia with Lewy bodies.
Dementia
Published in Jane Higgs, Gill Wakley, Ruth Chambers, Clare Gerada, Demonstrating your Clinical Competence in Depression, Dementia, Alcoholism, Palliative Care and Osteoporosis, 2018
Jane Higgs, Gill Wakley, Ruth Chambers, Clare Gerada
The North of England evidence-based guidelines development project and the Scottish Intercollegiate Guidelines Network (SIGN) give similar recommendations for pharmacological treatments.16,17 Neuroleptic drugs are the mainstay of pharmacological treatment for Alzheimer’s disease but they do have side-effects such as parkinsonism, drowsiness, tardive dyskinesia, falls accelerating cognitive decline, and severe neuroleptic sensitivity reactions. Patients with dementia from Lewy bodies are more sensitive to the side-effects of neuroleptic medication and should not be prescribed these medications, so an accurate diagnosis is imperative.16 Behavioural problems (e.g. aggression or restlessness) change with the course of the dementia, therefore medication should be reviewed regularly to see if it is still needed.18
Dementia awareness
Published in Grahame Smith, Dementia Care, 2018
Dementia with Lewy bodies is the second most common neurodegenerative disorder after Alzheimer’s disease and is defined as a degeneration in the central, peripheral and autonomic nervous system associated with Lewy bodies (Fujishiro et al., 2013). Presenting symptoms include language, concentration and coordination problems which can result in frequent falls. The loss of memory is not as obvious as in other dementias but the person may fluctuate between periods of lucidity and confusion. Auditory and visual hallucinations are common and can be distressing for the patient and the patient’s family (McKeith & Fairbairn, 2001; Walsh, 2006).
Early-start vs delayed-start donepezil against cognitive decline in Parkinson disease: a randomized clinical trial
Published in Expert Opinion on Pharmacotherapy, 2021
Hideyuki Sawada, Tomoko Oeda, Masayuki Kohsaka, Satoshi Tomita, Atsushi Umemura, Kwiyoung Park, Kenji Yamamoto, Kosuke Kiyohara
Patient eligibility criteria for phase 1 were the following: 20–80 years of age (inclusive) at the time of signing the consent, diagnosed as PD according to steps 1 and 2 of the United Kingdom Brain Bank Parkinson’s disease criteria, with modified Hoehn-Yahr (mH-Y) stage from 2.5 to 4 (‘ON’ period if patients suffered from motor fluctuations), and MMSE scores of 24 or more [19]. For 8 weeks before study enrollment, patients must have had no hallucinations or delusions according to the Parkinson Psychosis Questionnaire (PPQ), because the original purpose of EDAP was to investigate the prophylactic effect of donepezil against psychosis in PD. Exclusion criteria for phase 1 were the following: 1) taken donepezil, 2) taken central anticholinergic drugs within 4 weeks prior to week 0, 3) taken Yokukansan within 4 weeks, 4) taken antipsychotics within 12 weeks, 5) patients who fulfilled the criteria of probable dementia with Lewy bodies, 6) diagnosed with schizophrenia, 7) history of stereotactic surgery, 8) allergic to piperidine derivatives, 9) severe hepatic or renal dysfunction, 10) sick sinus syndrome or intra-atrial or AV nodal block, 11) patients with present or previous serious gastrointestinal ulcer, bronchial asthma or obstructive pulmonary diseases, 12) bradycardia (heart rate of 45 bpm or less), 13) QTc time longer than 460 ms, 14) pregnant or feeding a baby, 15) having participated in other clinical trials within 12 weeks, 16) diagnosed with malignancy, or 17) judged as not suitable by the investigators.
Immunization therapies for Parkinson’s disease: state of the art and considerations for future clinical trials
Published in Expert Opinion on Investigational Drugs, 2020
Angelo Antonini, Daniele Bravi, Michele Sandre, Luigi Bubacco
The formation of abnormal aggregates of the synaptic protein, α-Syn, represents the dominant pathology in synucleinopathies. The cellular aggregation of the protein occurs in three distinct types of inclusions: neuronal Lewy bodies and Lewy neurites in PD and dementia with Lewy bodies (DLB) (as well as incidentally in a number of other conditions).oligodendroglia cytoplasmic inclusions in multiple system atrophy (MSA).large axonal spheroids in a number of rarer neuroaxonal dystrophies [7].
Advances in the pharmacotherapeutic management of dementia with Lewy bodies
Published in Expert Opinion on Pharmacotherapy, 2018
Giovanni Palermo, Roberto Ceravolo, Ubaldo Bonuccelli
This article reviews the current pharmacotherapy of DLB (Table1) and highlights the latest developments in the therapeutic approach to DLB (Table2). A literature review of published studies was conducted via the PubMed database of the US National Library of Medicine (www.pubmed.org) using the search term DLB, restricting our search to the evidences for pharmacological interventions in patients with a diagnosis of DLB according to the current criteria [1]. In addition, we examined the more recent trials registered within Clinicaltrials.gov using ‘Dementia with Lewy Bodies and Lewy Body Dementias’ as the keywords.