Cognitive fluctuations in Lewy body dementia: towards a pathophysiological framework

Elie Matar*, James M. Shine, Glenda M. Halliday, Simon J. G. Lewis

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

63 Citations (Scopus)

Abstract

Fluctuating cognition is a complex and disabling symptom that is seen most frequently in the context of Lewy body dementias encompassing dementia with Lewy bodies and Parkinson's disease dementia. In fact, since their description over three decades ago, cognitive fluctuations have remained a core diagnostic feature of dementia with Lewy bodies, the second most common dementia in the elderly. In the absence of reliable biomarkers for Lewy body pathology, the inclusion of such patients in therapeutic trials depends on the accurate identification of such core clinical features. Yet despite their diagnostic relevance, cognitive fluctuations remain poorly understood, in part due to the lack of a cohesive clinical and scientific explanation of the phenomenon itself. Motivated by this challenge, the present review examines the history, clinical phenomenology and assessment of cognitive fluctuations in the Lewy body dementias. Based on these data, the key neuropsychological, neurophysiological and neuroimaging correlates of cognitive fluctuations are described and integrated into a novel testable heuristic framework from which new insights may be gained.

Original languageEnglish
Pages (from-to)31-46
Number of pages16
JournalBrain
Volume143
Issue number1
Early online date15 Oct 2019
DOIs
Publication statusPublished - 1 Jan 2020
Externally publishedYes

Keywords

  • Arousal
  • Attention
  • Cognitive fluctuations
  • Lewy body dementia
  • Parkinson's disease

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