After Alzheimer's disease, the second most common form of dementia is vascular dementia, which is a direct result of multiple strokes destroying large portions of brain tissue (discussed in chapter 12).
Diffuse Lewy body disease is a diagnosis that has gained in popularity in the 1990s. Lewy bodies are microscopic structures present in the brains of patients with Parkinson's disease. At least one-third of Alzheimer's patients also have clinical features of Parkinson's disease: tremor, slow movements, rigidity of muscles, and difficulty in walking. Some of these patients have Lewy bodies in addition to the typical Alzheimer's autopsy findings of neurofibrillary tangles and amyloid plaques. A British group headed by Ian McKeith has led the charge in calling for a separate diagnostic category called diffuse Lewy body disease, which has the clinical features of dementia, Parkinsonian signs, fluctuating memory loss and confusion, hallucinations, and extreme sensitivity to antipsychotic medications. Many cases previously called Alzheimer's are now called Lewy body disease; this topic remains controversial.
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