Which form of dementia is associated with Lewy body pathology and can include visual hallucinations, fluctuations in attention, and falls?

• A. Parkinson disease
• B. Frontotemporal dementia
• C. Vascular dementia
• D. Lewy body dementia

Answer: (D)

Lewy body dementia involves Lewy body pathology and is marked by visual hallucinations, fluctuations in attention, and falls. Lewy bodies are abnormal aggregates of alpha-synuclein that accumulate in cortical and subcortical areas, leading to a mix of cognitive and motor symptoms. The typical picture includes vivid visual hallucinations, pronounced and sometimes unpredictable changes in alertness and attention, and parkinsonian features that can increase fall risk. REM sleep behavior disorder is also commonly seen. This combination helps set it apart from other dementias: frontotemporal dementia usually presents with early personality or language changes; vascular dementia tends to show stepwise declines with focal neurological signs; Parkinson disease dementia often follows a long period of motor symptoms, whereas dementia with Lewy bodies characteristically has cognitive symptoms emerging early or concurrently with parkinsonism.