Dementia With Lewy Bodies

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Combining both features of a primary degenerative dementia and an akinetic-rigid, parkinsonian syndrome with prominent behavioral features, dementia with Lewy bodies (DLB) illustrates some of the

Table 21

Acute Intoxication Owing to Opioid Use

A. The general criteria for acute intoxication must be met.

B. There must be dysfunctional behavior, as evidenced by at least one of the following:

1. Apathy and sedation.

2. Disinhibition.

3. Psychomotor retardation.

4. Impaired attention.

5. Impaired judgment.

6. Interference with personal functioning.

C. At least one of the following signs must be present:

1. Drowsiness.

2. Slurred speech.

3. Pupillary constriction (except in anoxia from severe overdose, when pupillary dilatation occurs).

4. Decreased level of consciousness (e.g., stupor, coma).

Comment: When severe, acute opioid intoxication may be accompanied by respiratory depression (and hypoxia), hypotension, and hypothermia.

Table 22

Acute Intoxication Owing to Cannabinoid Use

A. The general criteria for acute intoxication must be met.

B. There must be dysfunctional behavior or perceptual abnormalities, including at least one of the following:

1. Euphoria and disinhibition.

2. Anxiety or agitation.

3. Suspiciousness or paranoid ideation.

4. Temporal showing (a sense that time is passing very slowly, and/or the person is experiencing a rapid flow of ideas).

5. Impaired judgment.

6. Impaired attention.

7. Impaired reaction time.

8. Auditory, visual, or tactile illusions.

9. Hallucinations with preserved orientation.

10. Depersonalization.

11. Derealization.

12. Interference with personal functioning.

C. At least one of the following signs must be present:

1. Increased appetite.

3. Conjunctival injection.

4. Tachycardia.

shortcomings of current nosological schemata. Lewy bodies are the pathological hallmark of Parkinson's disease, where they are primarily restricted to substantia nigra and pigmented brainstem nuclei. However, the presence of Lewy bodies in the cerebral cortex coupled with behavioral symptoms, such as visual hallucinations, led to the recognition of DLB as a distinct syndrome. Complicating this assessment is the presence of AD pathology in about 50% of autopsies of clinically diagnosed cases of DLB, leading to the concept of a Lewy body variant of AD. A number of diagnostic criteria have been proposed and are summarized in Table 46. A number of studies, utilizing varying proportions of DLB cases have reported validity, and reliability of the clinical criteria of DLB, often in relation to populations of AD or other mixed dementia groups (summarized in Table 47). Because positive and negative predictive values will vary according to the prevalence in the population, the small sample sizes and possibly relatively high proportion of true DLB cases in the referenced studies may overestimate these values in routine clinical practice. At present, the most important and widely used set is that proposed by McKieth et al. in their 1996 revision of the consensus criteria (Table 48).

Table 23

Acute Intoxication Owing to Sedative or Hypnotics Use

A. The general criteria for acute intoxication must be met.

B. There is dysfunctional behavior, as evidenced by at least one of the following:

1. Euphoria and disinhibition.

2. Apathy and sedation.

3. Abusiveness or aggression.

4. Lability of mood.

5. Impaired attention.

6. Anterograde amnesia.

7. Impaired psychomotor performance.

8. Interference with personal functioning.

C. At least one of the following signs must be present:

1. Unsteady gait.

2. Difficulty in standing.

3. Slurred speech.

4. Nystagmus.

5. Decreased level of consciousness (e.g., stupor, coma).

6. Erythematous skin lesions or blisters.

Comment: When severe, acute intoxication from sedative or hypnotic drugs may be accompanied by hypotension, hypothermia, and depression of the gag reflex.

Table 24

Acute Intoxication Owing to Cocaine Use

A. The general criteria for acute intoxication must be met.

B. There must be dysfunctional behavior or perceptual abnormalities, as evidenced by at least one of the following:

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