Dementia with Lewy bodies — MRCPsych Paper A MCQ

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EasyNeuropathologyDementia with Lewy bodiesMRCPsych Paper A

A 76-year-old man develops progressive cognitive decline accompanied by marked fluctuations in attention and alertness, recurrent well-formed visual hallucinations and spontaneous parkinsonism. Which neuropathological finding is most likely at post-mortem examination?

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Correct answer: B — Intraneuronal Lewy bodies containing alpha-synuclein

The correct answer is B. Fluctuating cognition, recurrent well-formed visual hallucinations and spontaneous parkinsonism are characteristic core features of dementia with Lewy bodies. Its defining neuropathology is Lewy bodies and Lewy neurites containing aggregated alpha-synuclein, including involvement of limbic and neocortical regions. Pick bodies are tau-positive inclusions associated with Pick disease, a frontotemporal lobar degeneration. Hirano bodies may occur in ageing and Alzheimer disease but are not the predominant lesion in dementia with Lewy bodies. Motor-neuronal TDP-43 inclusions suggest motor neurone disease pathology, sometimes within the frontotemporal dementia spectrum. Vascular beta-amyloid indicates cerebral amyloid angiopathy; amyloid co-pathology can occur in dementia with Lewy bodies but is not its defining lesion.

Reference: Bencze J, Seo W, Hye A, Aarsland D, Hortobágyi T. Dementia with Lewy bodies - a clinicopathological update. Free Neuropathology. 2020. https://pubmed.ncbi.nlm.nih.gov/37283665/