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Lewy body-demens

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Sakkunnig:
Definition:
Lewy body-demens är en synukleinopati, vilket innebär ett neurodegenerativt tillstånd med onormal ansamling av alfa-synuklein. Hög ålder, manligt kön och genetiska riskfaktorer predisponerar för sjukdomen.
Förekomst:
Lewy body-demens är det näst vanligaste neurodegenerativa tillståndet, efter Alzheimers sjukdom.
Symtom:
Kärnsymtomen är framträdande fluktuationer i uppmärksamhet och vakenhet, upprepade synhallucinationer, störd drömsömn (REM sömnstörning) och spontan parkinsonism.
Kliniska fynd:
Patienter med Lewy body-demens är ofta väl orienterade men långsamma i tanken och har svårt att bedöma avstånd och uppfatta saker tredimensionellt. Eventuella minnesproblem uppkommer ofta sent i förloppet.
Diagnostik:
Neuropsykologiska undersökningar kan eventuellt vara av värde i tidig fas vid Lewy body-demens för att fånga visuospatiala och exekutiva svårigheter, och påvisa förhållandevis bättre minnesfunktion. DT eller MR visar ofta bevarade temporallober, om inte en blandbild med Alzheimer föreligger. DAT scan eller Dopa PET visar ofta nedsatt dopamintransport, som vid Parkinsons sjukdom.
Behandling:
Huvudsaklig behandling är organiserande av stödåtgärder. Kolinesterashämmare är förstahandsval i medicineringen.
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  • Elisabet Londos, professor och överläkare, Minneskliniken, Skånes universitetssjukhus
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Peter D. Jost, spesialist allmennmedisin, redaktør NEL