Parkinsons Disease and Lewy Body Dementia

Course Leader

Michelle Dhanak, MD, has been in clinical practice for almost 25 years as an Internist and Geriatrician. She attended the University of Massachusetts Medical School, and completed her medical residency in internal medicine at Highland General Hospital in Oakland.

For the past nine years, she has practiced in New Zealand as a geriatrician, caring for frail elders at home, before returning to the Bay Area and joining the ElderConsult Team in 2017.

Dr. Dhanak has extensive experience caring for people living with dementia. She believes in a holistic approach and the importance of partnering with patients and their families.

Dr Dhanak is passionate about promoting dignity, respect, autonomy and self-efficacy for elders. She has a particular interest in utilizing physical activity to maintain physical and cognitive health.

Learning objectives

Lesson 1 – Introduction

This lesson is an introduction to Dr Michelle Dhanak, including specialty details and introduction to previous work. 

On completion of this lesson learners will be familiar with Dr Dhanak and understand her professional role and specialty.

Lesson 2 – Parkinson’s Disease with Dementia Vs. Lewy Body Dementia

This lesson outlines the main differences between Parkinson’s Disease with Dementia and Lewy Body Dementia. The one-year rule is discussed in relation to diagnosis, alongside other key defining features of each condition. Differences and similarities are explored. The dangers of antipsychotic medications in relation to this patient group are discussed. 

On completion of this lesson the learner will:

• Be able to define the one-year rule 
• Have gained knowledge of the signs of, similarities, and differences between, Parkinson’s disease and Lewy Body Dementia.
• Be aware of the potential severe effects of neuroleptic medications on this patient group. 

Lesson 3 – Features, neuropathology and diagnosis of Lewy Body Dementia

This lesson covers the clinical features of Lewy Body Dementia and outlines the mechanism by which the disease progresses. Diagnostic techniques such as imaging are discussed – alongside identification of some challenges of diagnosis. 

On completion of this lesson the learner will: 

• Understand the role protein deposits play in the development of neurodegenerative disorders. 
• Understand the diagnosis pathway for Lewy Body Dementia, including challenges that may be encountered.
• Be aware of the types of imaging that may be used to support diagnosis. 

Lesson 4 – Visual Hallucinations, REM Sleep Disorder & Parkinsonism

This lesson covers hallucinations, REM Sleep Disorder and Parkinsonism as a feature of Lewy Body Dementia. The varied nature of hallucinations is discussed. The features of REM sleep disorder are explored. The key characteristics of Parkinsonism seen in Lewy Body Dementia are identified. 

On completion of this lesson the learner will:

• Be aware of the different types of hallucinations experienced by people living with Lewy Body Dementia. Understand why this feature of the disease is often identified late in the diagnosis process.
• Know the defining features of REM sleep disorder and understand how this presents in Lewy Body Dementia 
• Be able to identify the key characteristics of Parkinsonism presented in Lewy Body Dementia

Lesson 5 – Clinical Course, Prognosis & Treatment of Lewy Body Dementia

This lesson explores the prognosis, clinical course and treatment options of Lewy Body Dementia. Prognosis and approximate life expectancy is covered alongside discussion of how factors such as quality of care and socioeconomic status can significantly alter life expectancy. Treatment options are examined, with risks and benefits of each medication group discussed. Medications to avoid and their potential ill effects are identified. 

On completion of this lesson the learner will:

• Understand the clinical course of Lewy Body Dementia, and factors that can influence this.
• Be able to identify the key medications used to treat symptoms of Lewy Body Dementia and their risks and benefits. Be aware of medications to avoid in Lewy Body Dementia and their potential effects and risks. 
• Be able to identify the motor characteristics of Parkinson’s disease, and understand how these respond differently to Sinemet than Parkinsonism in Lewy Body Dementia. 

Lesson 6 – Features, Neuropathology and Diagnosis of Parkinson’s Disease with Dementia

This lesson covers identifying features and neuropathology of Parkinson’s Disease alongside description of the typical clinical diagnostic pathway for those experiencing symptoms of Parkinsonism. The types of imaging sometimes used in diagnosing Parkinson’s Disease are discussed.

On completion of this lesson the learner will:

• Know the key features, clinical course and basic neuropathology of Parkinson’s Disease
• Know the main symptoms people experience in early Parkinson’s Disease that prompt them to seek medical advice
• Know the typical diagnostic pathway for Parkinson’s Disease; including types of imaging that may be used. 

Lesson 7 – Clinical Course, Prognosis & Treatment of Parkinson’s Disease with Dementia

This lesson examines non-motor symptoms of Parkinson’s disease. Focus is on the symptom of cognitive decline. This is discussed in reference to the prevalence of dementia in late stage Parkinson’s disease. Life expectancies are compared for Parkinson’s Disease and Parkinson’s Disease with Dementia. Medications are covered thoroughly and in relation to specific symptoms. Medication cautions, adverse effects and risk/benefit balance are also discussed.

On completion of this lesson the learner will: 

• Be able to identify the non-motor symptoms of Parkinson’s Disease
• Be aware of the effects, and prevalence of cognitive decline and dementia in people living with Parkinson’s Disease. 
• Be able to identify some of the medications used for specific Parkinson’s Disease symptoms. Be aware of issues surrounding medications and worsening cognitive decline. Be aware of risk/benefit balance for people living with late state Parkinson’s disease. 

Summary

This course explores common features and diagnostic presentations of Lewy Body Dementia and Parkinson’s Disease, alongside information relating to diagnosis and treatment of both diseases . On completion of this course learners will be able to identify common features of both diseases, as well as the key differences between them. Learners will also be aware of the clinical course, progression and prognosis of both diseases.