What are hallmark clinical features of Lewy Body Dementia? (Select all that apply)

Rationale: A. Patients with Lewy Body Dementia (LBD) often develop motor symptoms similar to Parkinson’s disease, including rigidity, bradykinesia (slowness of movement), shuffling gait, and resting tremor. These parkinsonian features can appear early or concurrently with cognitive changes, making them a key distinguishing characteristic from Alzheimer’s disease, where motor symptoms typically appear later. B. Individuals with LBD are particularly sensitive to both typical and some atypical antipsychotics. Administration of these drugs can result in severe extrapyramidal side effects, sudden worsening of motor function, sedation, or even life-threatening reactions. This sensitivity is a critical consideration for both diagnosis and safe treatment planning. C. Recurrent, well-formed visual hallucinations (e.g., seeing people, animals, or objects that are not present) are a hallmark feature of LBD. These hallucinations often appear early in the disease course and help differentiate LBD from Alzheimer’s disease, where hallucinations typically occur later or are less vivid. D. Behavioral changes, such as apathy, irritability, or mild disinhibition, may occur in LBD, but they are not considered defining features early in the disease. Significant behavioral changes are more characteristic of frontotemporal dementia rather than LBD. E. Sundowning and evening agitation are more commonly associated with Alzheimer’s disease and are not defining features of LBD. While agitation can occur in LBD, it is not as predictable or characteristic as in Alzheimer’s. F. Early language impairments are more typical of primary progressive aphasia or Alzheimer’s disease. In LBD, language tends to remain relatively intact in the early stages, with deficits more commonly seen in attention, executive function, and visuospatial skills. G. Early significant memory loss is a hallmark of Alzheimer’s disease, not LBD. In LBD, memory may be relatively preserved initially, with attention, visuospatial abilities, and executive functions more prominently affected. H. Fluctuating cognition is a core feature of LBD. Patients can have sudden shifts in attention, alertness, and cognitive performance, sometimes changing markedly within the same day. This fluctuation is one of the most distinguishing features of LBD compared to the steady cognitive decline seen in Alzheimer’s disease. I. While LBD is progressive, the rate of decline is variable. Rapid deterioration is not considered a hallmark feature and can occur in other dementias as well.