Alzheimer’s Vs Lewy Body Dementia

Lewy Body Composite Risk Score Assessment

The Lewy body composite risk score is an accurate, valid, and reliable tool for differentiating between Lewy body dementia and Alzheimers disease.

Reprinted with Permission from Dr. James E. Galvin. Galvin JE. Improving the clinical detection of Lewy body dementia with the Lewy body composite risk score. Alzheimers Dement . 2015 1:316-24.

The science behind dementia detection continues to change rapidly. Patients identified with dementia ideally should receive brain imaging to rule out other causes. PET and CSF biomarkers can be used to diagnose AD by testing for the presence of amyloid plaque and tau proteins in the brain or CSF. These tests are expensive.

Dopamine transporter imaging using single PET scans can be used to diagnose Parkinsons disease. Blood tests arent yet available for these dementias, but advances are being made. For example, Thijssen and colleagues tested for the presence of pTau181 protein in the blood plasma of 400 individuals and were successful in distinguishing those who were healthy from those with AD pathology. These findings were corroborated with two established biomarkers being used in AD research.

Treating Movement Symptoms In Lewy Body Dementia

LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.

People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.

How Is Lewy Body Dementia Treated

Theres no cure for Lewy body dementia . Medications and nonmedical therapies, like physical, occupational and speech therapies, manage symptoms as much as possible.

Medications that can help manage the symptoms of LBD include:

• Cholinesterase inhibitors: This type of medication, which includes rivastigmine, galantamine and donepezil, helps manage the cognitive symptoms of LBD.
• Carbidopa-levodopa: Symptoms of parkinsonism, like tremors, are usually treated with levodopa, a drug commonly used to treat Parkinsons disease. However, it has serious side effects and can lead to delusions, hallucinations and confusion.
• Pimavanserin: This medication can be used to treat psychosis in people with Parkinsons disease dementia.
• Clonazepamandmelatonin: These medications can help treat REM sleep behavior disorder.
• Antidepressants: Depression is common in people with LBD and often requires antidepressant therapy with selective serotonin reuptake inhibitors .
• Memantine: This drug is typically used to treat dementia caused by Alzheimers disease, but its been investigated in clinical trials and may work in people with LBD who are in the early phases of the condition.

People with LBD can take part in different therapies to improve their quality of life, including:

• Individual and family psychotherapies .

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Is There A Link

According to the Alzheimers Association, Alzheimers disease and LBD can overlap. Lewy bodies can occur in people with Alzheimers, and plaques and tangles key markers of Alzheimers disease occur in many individuals with LBD.

Although LBD and Alzheimers disease may share similar symptoms, they are different conditions and do not appear to lead to the other.

The following table compares the two conditions.

Both conditions typically affect older adults.

Screening For Memory Loss

Because of the importance of early detection, cognitive screening is now a required component of the Medicare/Medicaid annual wellness visit. Several measures are available that nurses can use to briefly assess for risk of cognitive decline. For example, the Quick Dementia Rating Scale is a 5-minute informant interview that addresses ten cognitive domains: memory and recall, orientation, decision-making and problem-solving abilities, activities outside the home, function at home and hobbies, toileting and personal hygiene, behavior and personality changes, language and communication abilities, mood, and attention and concentration. The QDRS format helps to avoid problems such as patient anxiety with cognitive testing, which can lead to refusing to be tested. The scale also can be completed by family members. Scores of the 30-item scale range from 0 to 30 . The QDRS has strong reliability and validity when correlated with other common cognitive assessment tools, such as the Clinical Dementia Rating scale and the Mini-Mental State Exam the Mini-Mental State Exam requires payment for use. In addition, the QDRS provides enough information to stage dementia severity, and it can be used by clinicians to determine the need for more formal testing.

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Imagine Being Told You Are Living With Alzheimers Disease Only To Discover You Have Been Misdiagnosed And Are Suffering From Another Neurodegenerative Condition At 52 Years Old Mike Belleville Was Diagnosed With Early

While Alzheimers and Lewy body dementia share some symptoms, there has not been as much research on the latter, said Dag Aarsland, a leading LBD and Parkinsons researcher from Kings College in London and a director of research at the University of Stavangers Centre for Age-Related Medicine.

According to Aarsland, this lack of awareness about LBD and its symptoms leads to a number of Alzheimers misdiagnoses. However, Aarsland believes it should be relatively easy for doctors to tell the difference between the two conditions with the right tools and an extensive conversation with patients and their caregivers about their medical history.

• Aarsland said that unlike Alzheimers, where memory issues are the main symptom until later stages, Lewy body dementia patients often suffer from hallucinations, sleep disorders and gait problems or balance issues early on.
• While there are no medications that can cure Alzheimers or LBD, some medications like Aricept may temporarily slow the progression of Lewy body dementia and are often more effective on those with LBD than Alzheimers.
• Other medications that are prescribed for Parkinsons or used to treat hallucinations may help relieve some LBD symptoms as well.

Being Patient spoke to Aarsland about the differences between Alzheimers, Lewy body dementia and Parkinsons, if genetics impact whether or not someone will develop LBD, treatment options and where research on the neurodegenerative condition is headed.

What Are The Most Common Types Of Dementia

• Alzheimers disease. This is the most common cause of dementia, accounting for 60 to 80 percent of cases. It is caused by specific changes in the brain. The trademark symptom is trouble remembering recent events, such as a conversation that occurred minutes or hours ago, while difficulty remembering more distant memories occurs later in the disease. Other concerns like difficulty with walking or talking or personality changes also come later. Family history is the most important risk factor. Having a first-degree relative with Alzheimers disease increases the risk of developing it by 10 to 30 percent.

• Vascular dementia. About 10 percent of dementia cases are linked to strokes or other issues with blood flow to the brain. Diabetes, high blood pressure and high cholesterol are also risk factors. Symptoms vary depending on the area and size of the brain impacted. The disease progresses in a step-wise fashion, meaning symptoms will suddenly get worse as the individual gets more strokes or mini-strokes.

• Lewy body dementia. In addition to more typical symptoms like memory loss, people with this form of dementia may have movement or balance problems like stiffness or trembling. Many people also experience changes in alertness including daytime sleepiness, confusion or staring spells. They may also have trouble sleeping at night or may experience visual hallucinations .

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Special Concerns For The Caregivers

Caregivers of patients with LBD are stressed in many of the same ways as caregivers of AD patients. The cognitive decline, decreasing functional capacity, and non-cognitive disturbances are every bit as stressful. In addition, though, LBD patients can present special concerns because their ability to function changes from day to day. Their falls and hallucinations add further stress and risk. Their response to cognitive enhancers such as the cholinesterase inhibitors or memantine can be as good as that of AD patients, so their use should be considered.

Assessment Is Key For Optimal Management

Takeaways:

• An early symptom of Alzheimers disease is decline in cognition, most typically manifesting as short-term memory loss. Early symptoms of Lewy body dementia are characterized by cognitive, behavioral, movement, and autonomic changes.
• Common early signs of Lewy body dementia include visuospatial disturbances, vivid hallucinations, bradykinesia and rigidity and postural hypotension, loss of smell, and constipation.
• Strategies for managing symptoms in these two conditions vary.
• Screening and early dementia diagnosis provide opportunities to pursue health behaviors that can reduce risk, for earlier medication initiation to help moderate symptoms, to slow progression, and for long-term care planning.

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What Are The Signs And Symptoms Of Lewy Body Dementia

The most common symptoms of LBD include changes in thinking abilities, movement, sleep, and behavior. The degree of symptoms can vary widely and people with LBD may not have every symptom. Common symptoms include:

• Trouble with attention, planning, multitasking, problem-solving, and reasoning. Memory problems are also common but may not be noticeable early on.
• Problems with visual and spatial abilities, such as judging distance and depth or misidentifying objects.
• Unpredictable changes in concentration, attention, alertness, and wakefulness.
• Visual hallucinations, which occur in up to 80% of people with LBD, often early on.
• Movement changes, such as tremor or muscle stiffness, known as parkinsonism.
• Sleep disorders, including rapid eye movement sleep behavior disorder in which a person seems to act out dreams while asleep, excessive sleep or lack of sleep, and restless leg syndrome.
• Depression, lack of interest, anxiety, ideas not based in reality, and other changes in mental health.
• Sensitivity to heat and cold, dizziness, poor sense of smell, and other changes in automatic functions of the body.

Individuals with mild symptoms can often function close to normally. As the disease progresses and thinking and movement abilities decline, people with LBD will need more help and may depend on caregivers full time.

Types Of Lewy Body Dementia And Diagnosis

LBD refers to either of two related diagnoses dementia with Lewy bodies and Parkinson’s disease dementia. Both diagnoses have the same underlying changes in the brain and, over time, people with either diagnosis develop similar symptoms. The difference lies largely in the timing of cognitive and movement symptoms.

In DLB, cognitive symptoms develop within a year of movement symptoms. People with DLB have a decline in thinking ability that may look somewhat like Alzheimer’s disease. But over time, they also develop movement and other distinctive symptoms of LBD.

In Parkinson’s disease dementia, cognitive symptoms develop more than a year after the onset of movement symptoms . Parkinson’s disease dementia starts as a movement disorder, with symptoms such as slowed movement, muscle stiffness, tremor, and a shuffling walk. These symptoms are consistent with a diagnosis of Parkinson’s disease. Later on, cognitive symptoms of dementia and changes in mood and behavior may arise.

Not all people with Parkinson’s disease develop dementia, and it is difficult to predict who will. Many older people with Parkinson’s develop some degree of dementia.

Caregivers may be reluctant to talk about a person’s symptoms when that person is present. Ask to speak with the doctor privately if necessary. The more information a doctor has, the more accurate a diagnosis can be.

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This Disgusting Habit Can Increase Your Risk Of Dementia And Alzheimer’s

New research suggests there’s a connection between nose-picking and dementia. While there’s many risk factors for dementia such as age, family history, poor diet, lack of sleep and not enough physical activity, nose-picking might be added to the list. The bad habit can result in bacteria traveling through the nasal cavity’s olfactory nerve and reaching the brain creating markers that are “a tell-tale sign of Alzheimer’s disease,” according to research by Australia’s Griffith University.

The study, which was published in Scientific Reports in February, has recently generated a lot of media attention after a press release from the university was sent out suggesting nose picking could increase the chance of dementia and Alzheimer’s. Professor James St. John, the study’s co-author and head of the Clem Jones Center for Neurobiology and Stem Cell Research, said in a press release, “We’re the first to show that Chlamydia pneumoniae can go directly up the nose and into the brain where it can set off pathologies that look like Alzheimer’s disease.”

Eat This, Not That! Health spoke with Dr. J. Wes Ulm, Harvard and MIT-trained MD, PhD with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting and education who was not affiliated with the study, but explains the findings of the research and what to know about the data. Read onand to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

There’s No Evidence In Humans Yet

Dr. Ulm tells us, “Although the Griffith University team’s research was conducted in mice and the phenomenon has not yet been directly demonstrated in humans nonetheless their findings represent a proof-of-principle demonstration that mechanical disruption of the mammalian nasal lining, within the nostrils, can provide a route for bacterial invasion and deposition of amyloid-beta protein, present within the amyloid plaques in the brain closely associated with Alzheimer’s disease.

There had already been a number of hypotheses and suggestions that such a phenomenon was possible. Clinicians and scientists have long been aware of the olfactory nerve, responsible for our sense of smell, as representing a kind of “back door” into the central nervous system that bypasses most of the anatomical firewalls of the blood-brain barrier . The olfactory nerve is a cranial nerve, part of a group of specialized nerves involved in sensation, movement, and autonomic control .

But unlike the vast majority of cranial nerves which originate in the brainstem, a lower-down portion of the CNS that acts as a bridge between the spinal cord and brain the olfactory nerves originate much higher up, within a specialized brain structure called the olfactory bulbs. These then traverse a sponge-like structure called the cribriform plate, part of a skull bone called the ethmoid bone, from where they enter the nose.”

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How Do I Take Care Of Someone With Lewy Body Dementia

If you care for someone who has been diagnosed with Lewy body dementia , its important to learn about the condition and seek professional guidance to help care for them at home. Understanding LBD can help you cope with everyday challenges.

You may need to make changes to your home to make everyday life easier for them. For example, it helps to have a bright, cheerful and familiar environment. Its also important to make sure your home is safe and clear of any obstacles that could cause falls.

Your loved ones healthcare team can help guide you with these changes.

As insight and judgment skills decline in people with LBD, you may need to appoint someone else to oversee their finances. Before their decline in mental function is severe, its also important to clarify their wishes about care and financial and legal arrangements.

What Is The Link Between Parkinsons And Lewy Body Dementia

Being Patient: Are Parkinsons disease and Lewy body dementia related?

Dag Aarsland: Yes, theyre related in terms of symptoms and the brain changes. Many scientists consider Parkinsons and Lewy body dementia as a continuum of disease rather than two separate diseases. But there are very active and lively discussions about that. There are arguments for separating and combining them, but there are many similarities.

Being Patient: Do you group Lewy body dementia with Parkinsons disease in your research?

Dag Aarsland: From a research point-of-view, we try to separate them. We identify the specifics and categorize patients in different groups and study them carefully in order to see how they relate. In clinical practice, its different. I also see patients with Parkinsons and unfortunately, many of them develop dementia and hallucinations or memory problems. In clinical practice, its very much the same challenges for patients, carers and the doctor in terms of findings and the right therapy.

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Different Types Of Dementia

The term âdementiaâ is really an umbrella term for several diseases, including:

Now letâs dive deeper in to these two forms of dementia: Alzheimerâs Disease and Lewy Body Dementia.

Behavioral And Mood Symptoms Of Lewy Body Dementia

Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:

• Apathy, or a lack of interest in normal daily activities or events and less social interaction
• Anxiety and related behaviors, such as asking the same questions over and over or being angry or fearful when a loved one is not present
• Agitation, or restlessness, and related behaviors, such as pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
• Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living.
• Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things

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