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Denise Compton, Ph.D., geriatrics neuropsychologist, discusses differences between Lewy body dementia, Parkinson's disease and Alzheimer's. Image by Evan Lewis

Geriatrics Update Session Examines Lewy Body Dementia, Parkinson’s Disease, Alzheimer’s

Oct. 27, 2025 | October 27, 2025 | Health professionals and community members gathered Oct. 9-11 at the University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging to learn about a wide range of topics and the latest developments in the care of older adults.

The 29th annual three-day conference, “2025 Geriatrics Update: Living and Loving Longevity,” was opened by Jeanne Wei, M.D., Ph.D., professor and chair of the Department of Geriatrics and director of the institute.

The conference focused on cancer, cardiopulmonary issues, infectious diseases and pharmacology on its first day, then tackled endocrine and gastrointestinal matters, as well as neurocognitive impairment, on the second day. The third day was devoted to caring for the caregivers of patients living with cognitive disorders, including segments on “Getting one’s affairs in order” and on transitioning to facility living or 24/7 care.

Thirty-six speakers, mostly from UAMS, provided the latest information about diagnosis, treatment and research for an audience consisting primarily of physicians, physician assistants, nurses, pharmacists, dieticians and other health professionals.

A session on neurocognitive impairment was organized by Gohar Azhar, M.D., a professor who holds the Jackson T. Stephens Distinguished Chair in Geriatrics Clinical Affairs and is the director of the Walker Memory Research Center and Memory Clinic. Speakers provided updates about Lewy body dementia, Parkinson’s disease and Alzheimer’s disease.

Denise Compton, Ph.D., associate professor and a geriatrics neuropsychologist at UAMS who holds the Magalene McKinnon Ingram Chair in Geriatric Education, said that despite being the second most common form of dementia after Alzheimer’s, Lewy body dementia is widely underdiagnosed.

She said Lewy bodies, which are misfolded alpha-synuclein proteins in the nerve cells of the brain (and were named after a neurologist who discovered them), are the cause of Lewy body dementia, Parkinson’s disease and multiple system atrophy.

However, in the early stages of Lewy body disease, the symptoms of these conditions can vary considerably, making diagnosis somewhat challenging.

Symptoms can include problems with sleep, particularly rapid eye movement (REM) sleep behavior disorder, in which a person acts out their dreams during REM sleep. There may also be motor symptoms, cognitive changes, autonomic dysfunction (damage to the nerves that control automatic body functions) and neuropsychiatric disturbances.

With Lewy body dementia, Compton said, “the prodromal (predementia) stage can last for up to 15 years,” during which there are very few signs and symptoms.

To diagnose Lewy body dementia, she said, “we tend to focus on visual hallucinations although it’s much broader than that — actually sensory disturbances, often visual spatial disturbances, diminished olfaction and cognitive decline — the most salient feature being fluctuating attention.”

Early indicators of Alzheimer’s disease, “even before our new wonderful blood tests and other biomarkers,” are often memory changes followed by a particular language problem, she said.

When Parkinsonism (tremors or muscular rigidity) or REM sleep behavior disorder are present along with other indicators, “it strongly predicts transition to Lewy Body dementia and not Alzheimer’s,” Compton said.

“When isolated REM sleep behavior disorder presents, up to 90% of patients will convert to a neurodegenerative disorder, primarily Lewy body dementia or Parkinson’s disease — and sometimes this is precipitated by initiation of treatment with an SSRI,” she said, referring to selective serotonin reuptake inhibitors, a class of antidepressant drugs.

“If we see visual hallucinations, we’re on the track to diagnosing Lewy body dementia,” she added. “These can be either spontaneous or provoked by illness or medication, meaning delirium. So, delirium is likely to occur in Lewy body disorder much more commonly than with Alzheimer’s disease.”

In Lewy Body dementia, Compton said, “we see mostly cognitive changes with attention, executive functions and visual processing deficits — while memory and language, particularly object-naming functions, are relatively well preserved.”

“In terms of hallucinatory phenomena, the core criteria for Lewy body dementia are well-formed, detailed visual hallucinations,” she said. “But in the earliest prodromal stages, those hallucinations may be passage or presence hallucinations. Passage hallucination patients will describe seeing something moving in their peripheral visual field. They’ll often say, ‘I thought I saw a little animal running along a wall,’ or a mouse running across the floor, ‘but when I look, I can’t find it.’

Presence hallucinations often happen at night, in low lighting, when the patient senses the presence of somebody in the room who isn’t there and may even see a vague outline or image as well, she said.

“This is very common at the prodromal level, but I don’t know that we have that on our radars as much as we should,” she said.

There are some biomarkers for diagnosing Lewy body dementia, Compton said, but in the predementia stage, a negative test for the biomarkers doesn’t rule out the existence of the disease.

Kathryn Chenault, M.D., a neurologist who directs The Neurology Clinic and MS Clinic of Arkansas, discussed the diagnosis and management of Parkinson’s disease, saying its prevalence is rising globally in people 60 and older, “likely due to aging populations as well as improved diagnostic methods including information dissemination and educational measures that have increased awareness of the disease.”

Chenault said chemical exposures may also be to blame, noting, “Agent Orange was a big, big cause of Parkinson’s in patients who were in the Vietnam War.”

Parkinson’s is “the fastest growing neurologic disorder, with the number of affected individuals projected to double between 2021 and 2050,” she said.

Chenault said biomarkers for the alpha synucleinopathies will soon be available, and clinicians “need to come up with a plan” to help patients if the biomarkers find the presence of the disease perhaps 10 or 20 years before motor symptoms appear.

“This is a really big area of debate right now,” she said, referring to management plans for Parkinson’s with positive biomarkers without symptoms

While most patients who come to her clinic in search of a diagnosis are exhibiting motor symptoms of Parkinson’s, she said, “I see a lot of patients come in with bradykinetic Parkinsonism (movements that are slower than expected), and they’re surprised when they’re told they have Parkinson’s. This bradykinesia is a very, very typical problem.”

Elizabeth Eoff-McDaniel, M.D., assistant professor of geriatrics who sees patients in the Walker Memory Clinic, co-moderated the neurocognitive session with Azhar. She updated the audience on treatments for Alzheimer’s disease, discussing the latest anti-amyloid, disease-modifying monoclonal antibodies — lecanemab and donanemab — that slow the disease progression.

The drugs are recommended for patients aged 50-90 with mild cognitive impairment or early-stage dementia with biomarker-confirmed amyloid in the brain. They have some serious potential side effects, however, and patients must meet a number of specific criteria to be considered a safe candidate for using them, Eoff-McDaniel said.

Azhar continued the discussion on neurocognitive disorders on the third day, with a session called “Do I have Alzheimer’s disease?’ that was targeted to an audience of patients and caregivers who attended in person as well as on Zoom.

“Depression and delirium can often be confused with dementia” by caregivers or even providers, she said, noting that an incorrect diagnosis can result in delayed treatment for these conditions.

In addition, patients with cognitive impairment or dementia are more likely to develop delirium, Azhar said. Acute delirium is usually reversible, whereas dementia is generally progressive. A discussion focused on the various investigative steps needed to make a correct diagnosis.

Wei wrapped up the conference by praising all the speakers for their updates and thanking the audience for enthusiastically participating.

“We learn from one another and grow better together toward a healthier community,” she said.