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Advanced Neurology Dementia with Lewy bodies and substance misuse

versus one of 30 years, but use over 4 weeks is considered Funding
long term. 101,102 Studies are often unable to capture the
real-world experience of patients who may be on multiple None.
classes of antidepressants or opioids at one time or who go Conflict of interest
through several periods of withdrawal. By acknowledging
the clinical nature of SUD and treating it as such, more of The authors declare that they have no competing interests.
these complex, high-risk patients may seek treatment and Author contributions
be able to participate in research on prodromal dementias.
The neuropathology, biomarkers, and the effects of Conceptualization: Kelly Tuchman
treating the cause of the neuroinflammatory insult may be Investigation: Kelly Tuchman, Fraser Henderson
ascertained before the prodromal disease progresses into a Writing – original draft: Kelly Tuchman
proteinopathy. Writing – review & editing: All authors.
Advances in biomarkers (Table 1), such as the serum Ethics approval and consent to participate
protein markers; measuring dopamine uptake in the
basal ganglia using positron emission tomography or Written informed consent was obtained from the power
single photon emission CT, myocardial scintigraphy, and of attorney of the deceased patient for the use of patient
polysomnography; as well as increased awareness may help records for publication. No protected health information
providers in the future to detect DLB at earlier stages. (PHI) was used in the publication.
33
This will ease the burden on both the patients and their Consent for publication
families. In our case, once a diagnosis of DLB was made,
the patient’s family reported that they were relieved to Written informed consent was obtained from the power
learn that his symptom fluctuations were not caused by of attorney of the deceased patient for the use of patient
surreptitious substance misuse and started to focus on his records, including test results and pertinent medical history,
DLB care. for publication. No PHI was used in the publication.

4. Conclusion Availability of data
The diagnosis of DLB can prove challenging due to Not applicable.
its variable presentation and symptom fluctuations.
Substance misuse may mask or replicate symptoms of References
degenerative dementia. Substance misuse should not 1. Lewy Body Demenita Association. The LBD Spectrum. Available
deter providers from fully investigating the possibility from: https://www.lbda.org/about-lbd/#:~:text=lewy%20
of concurrent proteinopathies in symptomatic patients body%20dementia%20(lbd)%20is,parkinson’s%20disease%20
as the use of alcohol and benzodiazepines is a risk factor dementia%20(pdd [Last accessed on 2023 Oct 19].
for the development of proteinopathy. Over-reliance 2. Kane JPM, Surendranthan A, Bentley SAH, et al. Clinical
upon diagnostic instruments may result in the failure prevalence of Lewy body dementia. Alzheimers Res Ther.
to diagnose proteinopathies in the early, prodromal 2018;10(1):19.
stages when treatment can be the most effective. Early doi: 10.1186/s13195-018-0350-6
diagnosis helps prevent patient harm and eases caregiver
burden. Patients and providers should be made aware of 3. McKeith I. Clinical aspects of dementia with Lewy Bodies.
the dangers of long-term benzodiazepine use. Successful Handb Clin Neurol. 2008;89:307-311.
treatments for SUD that address neuroinflammation could doi: 10.1016/S0072-9752(07)01229-8
help prevent future-related cases of dementia and may have 4. Bouter C, Hansen N, Timäus C, Wiltfang J, Lange C. Case
general applications for prodromal dementia. SUDs and report: the role of neuropsychological assessment and
dependence on benzodiazepines must be de-stigmatized, imaging biomarkers in the early diagnosis of Lewy body
especially in the medical community so that patients may dementia in a patient with major depression and prolonged
feel free to seek proper treatment and that we may further alcohol and benzodiazepine dependence. Front Psychiatry.
our knowledge through collaborative research. 2020;11:684.
doi: 10.3389/fpsyt.2020.00684
Acknowledgments
5. Yamada M, Komatsu J, Nakamura K, et al. Diagnostic
The authors thank the patient’s family for the records and criteria for dementia with Lewy bodies: Updates and future
personal history shared. directions. J Mov Disord. 2020;13(1):1-10.

Volume 3 Issue 1 (2024) 11 https://doi.org/10.36922/an.2232