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Advanced Neurology

REVIEW ARTICLE
Unraveling the challenges of diagnosing

dementia with Lewy bodies in a patient with
alcohol and benzodiazepine misuse: A case

study-based review

1
Kelly Tuchman * and Fraser C. Henderson Sr 1,2
1 The Metropolitan Neurosurgery Group, LLC, Silver Spring, Maryland, United States of America
2 Department Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United
States of America

Abstract

Dementia with Lewy bodies (DLBs) is the second most common cause of
neurodegenerative dementia in the United States, after Alzheimer’s disease, and
is often misdiagnosed. A history of substance use disorder (SUD) complicates the
diagnosis process, and side effects of substance misuse can mirror or mask signs of
degenerative dementia. The fluctuating cognition and mobility which would normally
point toward DLB are erroneously seen as signs of SUD or polypharmacy. However, a
history of SUD should not preclude the diagnosis of DLB or other forms of proteinopathy,
as substance misuse can contribute to the development of neurodegenerative
dementias. Both alcohol and benzodiazepines have a sedative effect as ligands to
*Corresponding author:
Kelly Tuchman gamma-aminobutyric acid (GABA) receptors. Long-term use, misuse, and withdrawals
(kelly@metropolitanneurosurgery. can upset the delicate GABAergic/glutamatergic balance, resulting in adverse
org) neuroimmune and neuroinflammatory responses which contribute to the pathologies
Citation: Tuchman K, seen in degenerative dementias, such as DLB. In this paper, we review the challenges,
Henderson FC. Unraveling the including limitations of standardized instruments for dementia and the harms of
challenges of diagnosing dementia
with Lewy bodies in a patient delayed diagnosis, in DLB diagnosis, in combination with our experiences drawn
with alcohol and benzodiazepine from studying a polypharmacy-practicing 68-year-old man with a 40-year history of
misuse: A case study-based review. benzodiazepine and alcohol use. Understanding the underlying mechanisms of SUD
Adv Neuro. 2024;3(1):2232.
https://doi.org/10.36922/an.2232 serves to destigmatize the condition to expedite treatment and further our knowledge
of the relationship between neuroinflammation and dementia.
Received: November 11, 2023
Accepted: February 15, 2024
Keywords: Lewy body disease; Dementia; Substance use disorder; Alpha-synuclein;
Published Online: March 13, 2024 Reactive oxygen species; Alzheimer’s disease
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, 1. Introduction
and reproduction in any medium,
provided the original work is Dementia with Lewy bodies (DLBs) is the second most common cause of
1
properly cited. neurodegenerative dementia in the United States, after Alzheimer’s disease (AD), with a
2
Publisher’s Note: AccScience prevalence of 15 – 20% of all dementia cases. Nevertheless, the early stages of DLB can be
Publishing remains neutral with difficult to diagnose due to its hallmark characteristic of fluctuation in cognition and its
regard to jurisdictional claims in similarities with other degenerative dementias in the prodromal phase. The presence of
3,4
published maps and institutional
affiliations. dementia is essential for a diagnosis of DLB. Dementia is defined as progressive cognitive
Volume 3 Issue 1 (2024) 1 https://doi.org/10.36922/an.2232