Major or Mild Neurocognitive Disorders with Lewy Bodies

Neurocognitive disorder with Lewy bodies (LB-NCD) is a leading cause of non-Alzheimer-disease-related NCDs. It is frequently underdiagnosed and misdiagnosed as NCD due to Alzheimer disease or Parkinson disease-related NCD. It should be considered in the differential of new-onset cognitive impairment and/or parkinsonian symptoms in older adults. It is marked by a combination of motor, sleep, and autonomic dysfunction and cognitive and other neuropsychiatric symptoms. Definitive diagnosis can only be made on autopsy. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Dementia with Lewy Bodies (DLB) consortium have developed a set of criteria for diagnosis based on core and suggestive features of the disease. Development of these symptoms within 1 year of each other strongly suggests a diagnosis of LB-NCD. Treatment with cholinesterase inhibitors may help slow the progression of cognitive deterioration. Low-potency dopamine blocking antipsychotics may be considered for treatment of hallucinations if benefits outweigh the risks of antipsychotic sensitivity.