They are present in 33% of DLB cases at the time of presentation (range 11 %-64%) and occur at some point during the course of the illness in 46% (13%-80%).56 Wellformed, detailed, and animate figures are experienced, provoking emotional responses varying through fear, amusement, or indifference, usually with some insight into the unreality of the episode once it. is over. It. has been suggested that repeated visual hallucinations and associated visual phenomena in DLB are underpinned by disturbances in a lateral frontal cortex–ventral visual stream system,57 emphasizing the cognitive basis

of such symptoms. Visual hallucinations in DLB Inhibitors,research,lifescience,medical are associated with greater deficits in cortical acetylcholine58 and predict better response to cholinesterase inhibitors.59 Motor parkinsonism Extrapyramidal signs (EPS) are reported in 25% to 50% of DLB cases at diagnosis,

and 75% to 80% of patients develop some EPS during the natural course. The profile of EPS in DLB is generally similar to that in agematched nondcmentcd PD patients25 with greater postural Inhibitors,research,lifescience,medical instability and facial impassivity, but less tremor.60 Rate of motor deterioration is about. 10% per annum, similar Inhibitors,research,lifescience,medical to PD,61 but Levodopa responsiveness is reduced, possibly due to additional intrinsic striatal pathology and dysfunction.62 Supportive features Repeated falls, syncope, and transient losses of consciousness Dementia of any etiology is probably a risk factor for all three of these Inhibitors,research,lifescience,medical clinical features and it can be difficult, to clearly distinguish between them. Repeated falls may be due to posture, gait, and balance difficulties, particularly in patients with parkinsonism. Reported fall rates are 28% at. the time of presentation (range 10%-38%) and 37% (22%-50%) at some point during Inhibitors,research,lifescience,medical the illness.56 Syncopal attacks in DLB with complete loss of consciousness and muscle

tone may represent the extension of LB-associated pathology to involve the brain stem and autonomic nervous system, leading to orthostatic hypotension and/or carotid sinus hypersensitivity, which are more science common in DLB than AD or age-matched controls.63 The associated phenomenon of transient episodes of unresponsiveness without loss of muscle tone may represent, one extreme of fluctuating attention and cognition. Neuroleptic sensitivity The hypothesis, first made by the Newcastle group, of an abnormal sensitivity to adverse effects of neuroleptic medication was based upon two sets of independent observations. In the first, 67% (14/21) DLB patients received neuroleptics and 57% (8/14) deteriorated rapidly after either receiving them for the first time, or following a dose BTK inhibitor increase.44 Mean survival time for these 8 patients was reduced to 7.4 months, significantly less than for the 6 patients who had only mild to no adverse reaction (28.5 months) and the 7 never receiving neuroleptics (17.8 months).