Confusable diagnoses · PANCE / PANRE

Alzheimer Disease vs Dementia with Lewy Bodies

Alzheimer Disease and Dementia with Lewy Bodies are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Alzheimer Disease vs Dementia with Lewy Bodies at a glance

  • Alzheimer Disease: Most common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology.
  • Dementia with Lewy Bodies: Neurodegenerative dementia with fluctuating cognition, recurrent visual hallucinations, parkinsonism, and REM sleep behavior disorder.
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Side-by-side comparison

FeatureAlzheimer DiseaseDementia with Lewy Bodies
At a glanceMost common neurodegenerative dementia; insidious memory loss with cortical amyloid and tau pathology.Neurodegenerative dementia with fluctuating cognition, recurrent visual hallucinations, parkinsonism, and REM sleep behavior disorder.
Classic presentationProfound short-term memory loss with relatively preserved older memories and intact remote procedural memory; hippocampal/medial temporal atrophy on MRI.;…Elderly patient with fluctuating cognition + well-formed visual hallucinations + parkinsonism + history of acting out dreams.; Cognitive fluctuations:…
Workup / key labsNIA-AA: probable AD dementia = insidious onset, progressive cognitive decline, predominant memory or non-amnestic syndrome, exclusion of other causes.…McKeith 2017 criteria: dementia + core features (fluctuating cognition, visual hallucinations, RBD, parkinsonism). Probable DLB = ≥2 core features OR 1 core +…
ImagingMRI brain (or CT if MRI contraindicated): generalized and disproportionate medial temporal/hippocampal atrophy; excludes vascular disease, NPH, masses,…MRI brain — relative sparing of medial temporal lobes (vs prominent hippocampal atrophy in AD); DaTscan SPECT — reduced striatal dopamine transporter uptake…
First-line treatmentCholinesterase inhibitor (AChE inhibitor) — donepezil, rivastigmine (oral or transdermal patch), galantamine; modest symptomatic benefit for mild-to-moderate…Cholinesterase inhibitors — rivastigmine (oral or transdermal), donepezil, galantamine — among the most responsive dementias to these agents; reduce…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.