Dementia cum corpusculis Leweyi

Cave: notitiae huius paginae nec praescriptiones nec consilia medica sunt.

Dementia cum corpusculis Leweyi est morbus neurodegenerativus et frequentia secundus ex frequentissimis cum dementiae symptomate. A prima origine proteina male plicata ex alpha-synucleino composita iuxta cerebri nervos et cellulas gliales corpusculaque Leweyi formantes aggregunt. Ita aggregata corpuscula Lewey mortem cellularum neuronales cum symptomatibus clinice apparentibus causant. Saepe cum aliis dementiarum generibus confunditur, quo fit, ut dementia haec rarius cognoscatur^[1].

In morbi concursu evolvunt symptomata multiplicia, ut cerebri (dementia) vel systematis nervosi autonomici. Profecto similitudines cum dementia apud morbum Parkinson notabiles sunt^[2], adeo ut quidam ambos morbos esse eosdem putant^[3].

Adhuc neque tractatio neque sanatio nota est^[4].

Neuropathologia

Sub microscopio dementia cum corpusculis Leweyi multa corpuscula inclusionis (corpuscula Leweyi enim) imprimis ex proteinis alpha-synucleino constitutis ostendit, at centesimae octoginta aegrotis etiam amyloidum beta (Aß) et proteinum tau intracerebralia sunt^[5].

Degeneratio nuclei basalis MEYNERT cholinergici observatur, quare usus medicamenta inhibitores cholinesterasis commendatur^[6].

Corpusculum Leweyi et alpha-synucleinum

Conferatur pagina principalis alpha-synucleinum.

Proteina alpha-synucleini intra cellulam nervalem aggregunt et eo modo corpuscula Leweyi formant. At aggregatio proteini alpha-synucleini non solum in dementia cum corpusculis Leweyi observatur, sed etiam in morbo Parkinson. Nimirum etiam mala cum morum mutatorum in somno, quae non raro cum morbo Parkinson sociata sunt, quoque in dementia hac investigari potuit^[7].

Alpha-synucleinum et cutis

Nuper proteini aggregatio in cute quoque demonstrata est. Videtur, ut praesentia alpha-synucleini semper cum aggregatione cutanea coniuncta sit^[8].

Diagnosis

Iam primum anno 2005 consortium dementiae cum corpusculis Leweyi commendationes suas divulgaverunt; Nuper, anno 2017 commendationes suas consensus criteria revisa poliverunt. Commendationes anni 2017 clarius distinguantur inter criteria clinia et pathologica^[9].

Consensus criteria clinica-diagnostica (2005)

Criteria consensu indicium centrale, indicia principalia, indicia multum indicantia, indicia sustentantia nominaverunt^[4]. Diagnosis medica praesentia indicii centralis una cum singulari indiciorum principalium poscit.

Indicium centrale

Dementia cum cottidiana mala functionum generalium. Initio memoria non inhibita videtur, sed saepe attentio vel functiones executivae et visuoperceptivae.

Indicia principalia

Sunt cognitiones fluctuantes velut attentio imprimis et vigilantia; alucinationes opticae, symptomata Parkinson.

Indicia sustentantia

Mala morum REM somni ut loquendi in somno. Graves effectus adversi post consumptionem antipsychoticorum. Actio diminuta dopaminergica in nucleis basalibus secundum SPECT vel PET.

Consensus criteria revisa (2017)

Commendationes revisae non solum in criteria clinica morum at vero in indices biologicos magis se iactant. Se extendit quoque tum malis morum somni REM tum in scintigraphia myocardiali ₁₂₃iodum-metaiodobenzylguanidino (MIBG). Praeterea officia diagnostica neuro-iconismi, examinationum electrophysiologicarum laboratoriique ibidem descripta sunt. Ita dividit commendatio currens inter criterium essentiale, indicia principalia, indicia sustentantia, indices biologici principales, velut indices biologici sustentantes. Diagnosis assumitur, si dementia et duo indicia principalia vel dementia, indicium principale quodvis, et index biologicus cognoscuntur.

Iconismus medicus

PET

Positronibus emissis tomographiae (PET) ope mutatio conspicua amygdalae aspicere potest: Adhibens fluorodeoxyglucoso PET (FDG-PET) observatur cerebri hypometabolismus, imprimis loborum occipitalium, at restant longe intacte et cortex cingularis posterior (signum cingularis posterioris) et corpus amygdaloideum (signum amygdalae)^[10]. Signum cingularis posterioris sane in dementia frontotemporali quoque se exponere queat.

Differentia versus dementiam Parkinsonianam

Generaliter dictum dementiam cum corpusculis Leweyi symptoma dementiae ante symptomata motuum ostendere vel concurrere. In morbo Parkinsoniano quidem symptomata motuum ante dementiam observantur. In medicina scientifica regula unius anni, quae ad initium malorum et mentis et motuum spectat, valida restat:

In dementia cum corpusculis Leweyi mala mentis intra unum annum una cum malis motuum.
In dementia Parkinsoniana primum mala motuum observatur. Oriuntur demum mala mentis post unum annum.

Notae

↑ Sanford A. M. (Nov 2018). "Lewy Body Dementia". Clinics in geriatric medicine 34 (4): 603-15
↑ Outeiro T. F., Koss D. J., Erskine D., Walker L., Kurzawa-Akanbi M., Burn D., Donaghy P., Morris C., Taylor J. P., Thomas A., et al. (2019). "Dementia with Lewy bodies: an update and outlook". Molecular neurodegeneration 14 (1): 5
↑ Jellinger K., Korczyn A. D. (Mar 2018). "Are dementia with Lewy bodies and Parkinson's disease dementia the same disease?". BMC Medicine 16 (1): 34
↑ ^4.0 ^4.1 McKeith I. G., Boeve B. F., Dickson D. W., Halliday G., Taylor J. P., Weintraub D., Aarsland D., Galvin J., et al. (2017). "Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium". Neurology 89 (1): 88-100 .
↑ Colom-Cadena M., Gelpi E., Charif S., Belbin O., Blesa R., Martí M. J., Clarimón J., Lleó A. (2013). "Confluence of α-synuclein, tau, and β-amyloid pathologies in dementia with Lewy bodies". Journal or neuropathology and experimental 72 (12): 1203-12
↑ Barrett M. J., Cloud L. J., Shah H., Holloway K. L. (Oct 2019). "Therapeutic approaches to cholinergic deficiency in Lewy body diseases". Expert Review of neurotherapeutics 12: 1-13
↑ Chan P. C., Lee H. H., Hong C. T., Hu C. J., Wu D. (Iun 2018). "REM Sleep Behavior Disorder (RBD) in Dementia with Lewy Bodies (DLB)". Behavioral neurology: 9421098
↑ Orimo S. (Aug 2018). "Autonomic Dysfunction and Skin Biopsy in Dementia with Lewy Bodies". Brain and nerve (Shinkei kenkyu non shinpo) 70 (8): 915-27
↑ McKeith I., Boeve B. F., et al. (Iul 2017). "Diagnosis and Management of Dementia With Lewy Bodies: Fourth Consensus Report of the DLB Consortium". Neurology (1): 88-100
↑ Pillai J. A., Wu G., et al. (Iul 2019). "Amygdala sign, a FDG-PET signature of dementia with Lewy Bodies". Parkinsonism and related disorders 64: 300-3

Nexus interni

Nexus externi

NIH de morbo. (Anglice)
NIH Informatio aegrotorum, familiarum. (PDF) (Anglice)

[1] Sanford A. M. (Nov 2018). "Lewy Body Dementia". Clinics in geriatric medicine 34 (4): 603-15

[2] Outeiro T. F., Koss D. J., Erskine D., Walker L., Kurzawa-Akanbi M., Burn D., Donaghy P., Morris C., Taylor J. P., Thomas A., et al. (2019). "Dementia with Lewy bodies: an update and outlook". Molecular neurodegeneration 14 (1): 5

[3] Jellinger K., Korczyn A. D. (Mar 2018). "Are dementia with Lewy bodies and Parkinson's disease dementia the same disease?". BMC Medicine 16 (1): 34

[Con2005-4] 4.0 ^4.1 McKeith I. G., Boeve B. F., Dickson D. W., Halliday G., Taylor J. P., Weintraub D., Aarsland D., Galvin J., et al. (2017). "Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium". Neurology 89 (1): 88-100 .

[5] Colom-Cadena M., Gelpi E., Charif S., Belbin O., Blesa R., Martí M. J., Clarimón J., Lleó A. (2013). "Confluence of α-synuclein, tau, and β-amyloid pathologies in dementia with Lewy bodies". Journal or neuropathology and experimental 72 (12): 1203-12

[6] Barrett M. J., Cloud L. J., Shah H., Holloway K. L. (Oct 2019). "Therapeutic approaches to cholinergic deficiency in Lewy body diseases". Expert Review of neurotherapeutics 12: 1-13

[7] Chan P. C., Lee H. H., Hong C. T., Hu C. J., Wu D. (Iun 2018). "REM Sleep Behavior Disorder (RBD) in Dementia with Lewy Bodies (DLB)". Behavioral neurology: 9421098

[8] Orimo S. (Aug 2018). "Autonomic Dysfunction and Skin Biopsy in Dementia with Lewy Bodies". Brain and nerve (Shinkei kenkyu non shinpo) 70 (8): 915-27

[9] McKeith I., Boeve B. F., et al. (Iul 2017). "Diagnosis and Management of Dementia With Lewy Bodies: Fourth Consensus Report of the DLB Consortium". Neurology (1): 88-100

[10] Pillai J. A., Wu G., et al. (Iul 2019). "Amygdala sign, a FDG-PET signature of dementia with Lewy Bodies". Parkinsonism and related disorders 64: 300-3

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