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1. The three types of dementia where Lewy bodies are
thought to cause clinical symptoms include:
A. PDD
B. AD
C. White matter disease
D. Diffuse Lewy body disease
E. Lewy body variant of AD
F. A, D, and E
2. Compared with AD, DLB is associated with:
A. Preserved object recognition
B. Preserved recall
C. Preserved verbal fluency
D. Intact visuospatial perception
E. A and B
3. Among the clinical assessment tools for fluctuation,
which one has been shown to detect drug treatment
effects?
A. Computer software testing systems
B. Clinician Assessment of Fluctuation Scale
C. One Day Fluctuation Assessment Scale
D. Mayo Fluctuation Composite Scale
4. What DLB symptom predicts response to ChEI
therapy?
A. VH
B. Cognitive impairment
C. Fluctuation
D. Impaired attention
5. What feature(s) are more prevalent in DLB than PD?
A. Cognitive impairment
B. Postural instability
C. Gait difficulty
D. Facial immobility
E. B, C, and D
6. Which suggestive feature(s) warrants a diagnosis of
probable DLB?
A. RBD
B. Severe neuroleptic sensitivity
C. Degeneration by DAT imaging
D. A and B
E. None of the above
7. EEG may prove to have good diagnostic utility by
providing the following information:
A. Quantification of postganglionic sympathetic
innervation
B. Prominent slow waves
C. Fluctuation among epochs
D. Transient temporal slow-wave activity
E. B, C, and D
8. Neuroleptics have NOT shown efficacy in open-label
trials for which of the following neuropsychiatric
symptoms of DLB?
A. Attention
B. Cognitive function
C. VH
D. Motor features
E. All of the above
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9. Sleep disturbances may be improved by bedtime
treatment with:
A. Clozapine
B. Haloperidol
C. Melatonin
D. Trazodone
E. A, B, and C
10. Loss of cholinergic and dopaminergic pathways
in DLB is attributed to Lewy body inundation of which
brain regions?
A. Downstream brainstem
B. Frontal lobes
C. Cingulated cortex
D. Subcortical nuclei
E. Hypothalamus
Case History
An established patient comes in for an office visit to
complain that his coordination is “off” and that he has
struggled with balancing his checkbook for the past
year. The patient is 70 years old, married, active, and
has no significant social history. He has a medical
history of hypertension and dyslipidemia for 20 years,
which have been well controlled, and periodic
depression that has required treatment three times
over the past 5 years. He typically reaches remission
after a 6-month course of SSRI therapy.
The patient’s wife confirms that she has taken over the
banking duties after some calculation errors were
discovered and that her husband has been
considering buying a walking cane because of
increasing unsteadiness.
On a recent trip to Spain, where they vacation often, he
became confused and had difficulty finding his way
while driving. He complains that he often wakes from
vivid dreams and then often feels sleepy during the
day. His wife confirms the presence of intense
dreams in which he calls out and thrashes about in
bed, thus disturbing her sleep as well.
On testing, the patient had normal orientation and
calculation ability. He had no language impairment
However, he could remember only three of five items
on a short-term recall test, and he had difficulty
drawing a clock and copying intersecting pentagrams.
His physical examination showed mild rigidity, but
normal postural stability.
Medications
Lisinopril/hydroclorothiazide 20/25 mg/day
Atorvastatin 40 mg/day
Periodic fluoxetine 40 mg/day
11. This patient presented with symptoms that
suggest DLB (e.g., visuospatial difficulty,
parkinsonism, RBD). Does he meet the updated
criteria for a diagnosis of probable DLB?
A. Inconclusive
B. Yes
C. No
12. Treating this patient’s periodic depression with a
tricyclic antidepressant is NOT recommended
because of potential for:
A. Gastrointestinal side effects
B. Anticholinergic activity
C. Increased parkinsonism
D. Agranulocytosis
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