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.
Parkinson’s Dementia Vs Dementia With Lewy Bodies
Have you ever wondered if there was any difference between dementia with Lewy bodies and Parkinson’s disease dementia? If you’ve ever heard the symptoms of these two disorders, they sound surprisingly alike. That’s because they’re both types of Lewy body dementia: dementia with Lewy bodies and Parkinson’s disease dementia .
What Is Lewy Body Dementia Causes Symptoms And Treatments
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Lewy body dementia is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood. Lewy body dementia is one of the most common causes of dementia.
LBD affects more than 1 million individuals in the United States. People typically show symptoms at age 50 or older, although sometimes younger people have LBD. LBD appears to affect slightly more men than women.
Diagnosing LBD can be challenging. Early LBD symptoms are often confused with similar symptoms found in other brain diseases or in psychiatric disorders. Lewy body dementia can occur alone or along with other brain disorders.
It is a progressive disease, meaning symptoms start slowly and worsen over time. The disease lasts an average of five to eight years from the time of diagnosis to death, but can range from two to 20 years for some people. How quickly symptoms develop and change varies greatly from person to person, depending on overall health, age, and severity of symptoms.
In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease advances, people with LBD require more help due to a decline in thinking and movement abilities. In the later stages of the disease, they often depend entirely on others for assistance and care.
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Outlook For Dementia With Lewy Bodies
How quickly dementia with Lewy bodies gets worse varies from person to person.
Home-based help will usually be needed, and some people will eventually need care in a nursing home.
The average survival time after diagnosis is similar to that of Alzheimer’s disease around 6 to 12 years. But this is highly variable and some people live much longer than this.
If you or a loved one has been diagnosed with dementia, remember that you’re not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.
What Are The 7 Stages Of Lewy Body Dementia
- Stage One: No Cognitive Decline. …
- Stage Two: Very Mild Cognitive Decline. …
- Stage Three: Mild Cognitive Decline. …
- Stage Four: Moderate Cognitive Decline. …
- Stage Five: Moderately Severe Cognitive Decline. …
- Stage Six: Severe Cognitive Decline. …
- Stage Seven: Very Severe Cognitive Decline.
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What Is Dementia With Lewy Bodies
Dementia with Lewy Bodies or Lewy Body Dementia is characterized by a progressive decline in cognitive abilities and independent functioning. The symptoms include changes in thinking and reasoning, delusions, confusion, hallucinations, sleep disturbances, and memory loss. Moreover, patients exhibit both dementia and movement symptoms such as slowness, gait imbalance, rigid muscles, tremor, and a shuffling walk. DLB is estimated to be dementias third most common cause as it is responsible for five to ten percent of cases .
This condition is due to the buildup of Lewy bodies which are spherical masses of protein that develop inside nerve cells. These were discovered by Frederic Henry Lewy, a Jewish German-born American neurologist, who worked in Dr. Alzheimers laboratory in the early 1900s. The risk factors include age and genetics. DLB has no cure however, medications may be prescribed to treat individual symptoms.
How Does Lewy Body Dementia Differ From Alzheimers Disease
Most are familiar with Alzheimerâs disease, but chances are, if you ask anyone on the street what Lewy body dementia is, they wonât have a clue. The prevalence of dementia with Lewy bodies is unknown, but dementia experts believe that LBD accounts for between 10% and 15% of all dementia cases.
As with other forms of dementia, LBD is a progressive brain disorder. It occurs when abnormal deposits of a protein called alpha-synuclein build up in the areas of the brain responsible for regulating behavior, cognition and movement. These deposits are called Lewy bodies. According to the Michael J. Fox Foundation for Parkinsonâs Research, there is compelling evidence from recent studies that alpha-synuclein may also play a role in the development of both familial and sporadic cases of Parkinson’s disease. In fact, LBD shares symptoms with both Alzheimerâs and Parkinsonâs disease.
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What Is Dementia With Lewy Bodies And Parkinsons
Both conditions relate to decline in cognitive thinking and reasoning, loss of brain cells and abnormal alpha-synuclein protein clusters termed as Lewy bodies.
Both disorders have very similar symptoms, but the symptoms usually happen in a different order dependant on where the Lewy bodies first form.
Major similarities between Parkinsons and Lewy Body Dementia include
- Both disorders affect approximately one million people in the United States
- They both cause an impact to the brain nerve cells
- There is no cure for both of these conditions
- Symptoms that impact the body include stiffness, weakness and slowness in movements
- Symptoms that affect brain include: memory loss, attention span and impaired executive functioning
The protein alpha-synuclein unusually builds up in the brain in aggregates, or clumps, called Lewy bodies. The location of those clumps makes a difference.
Also, people who have Lewy bodies dementia tend to exhibit greater variation in brain function ability than those with PD dementia.
Loss Of Cognition And Memory
Cognition is the mental process of acquiring knowledge and understanding through thought, experience, and the senses. With both LBD and Alzheimer’s, cognition is affected but in significantly different ways.
With LBD, the loss of cognition and memory can fluctuate. On one day, a person will LBD will not recognize a grandchild but, on the next, be able to recall the names of each of their grandchildren.
With Alzheimer’s, there may be variations, but the decline is generally steady, and there is not usually a big change from one day to the next. Over time, the gaps in lucidity become smaller and smaller.
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Dementia With Lewy Bodies
It is a degenerative neurologic disease in which dementia advances early on in the course of this health problem.
It is not a single medical condition but rather a spectrum of closely-associated medical conditions involving disturbances of sleep, autonomic function, cognition, behaviour, and movement.
Symptoms include
- Alterations in reasoning and thinking
- Slowness in movement and gait imbalance
- Poor regulation of body functions
- Fluctuating attention and depression
It represents 15%-25% of all dementias.
A Hypothetical Biomarker Profile Of Prodromal Dementia With Lewy Bodies
Figure 5
Hypothetical timelines of biomarker development. Biomarker development in dementia with Lewy bodies . This hypothesis mirrors that proposed by Jack and colleagues in Alzheimers disease . The first biomarkers of DLB will be markers of alpha-synuclein deposition . Syn deposition probably decreases later in the disease process following cell death . This would then be followed by markers of cell damage or death and then clinical symptoms/signs . Biomarkers in two different sites. In this hypothetical representation, Syn deposition, cell damage and loss and the development of symptoms all occur in the olfactory bulb prior to the development of Syn deposition in the neocortex.
Evidence supporting the presence of LB disease may need to be weighed against evidence for the presence of other diseases such as AD. However, amyloid deposition is often seen in DLB , and DLB can develop from amnestic MCI . The presence of amnestic MCI and a positive amyloid PET scan, sufficient for a diagnosis of prodromal AD or of MCI due to AD intermediate likelihood , is therefore also consistent with prodromal DLB.
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Symptoms Of Alzheimers Disease
Mild
- Problems recognizing friends and family
- Impulsive behavior
- Trouble following instructions or learning new information
- Hallucination or delusions
Typical age of diagnosis for Alzheimers disease: Mid-60s and above, with some cases in mid-30s to 60s
Typical age of diagnosis of frontotemporal dementia: Between 45 and 64
Typical age of diagnosis of Lewy body dementia: 50 or older
Typical age of diagnosis of vascular dementia: Over 65
The Link To Parkinsons Disease
Most people with Parkinsons disease have Lewy bodies in their brains. Its these clusters that cause some or all of the motor symptoms of Parkinsons disease, as well as memory or cognitive problems, visual hallucinations, and problems with alertness.
We rarely know if a living patient has Lewy bodies with certainty, however. Its not until an autopsy that they can be seen, says Liana Rosenthal, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine. If we see Lewy bodies in someones brain during an autopsy, thats considered a pathologic certainty of Parkinsons disease, she says.
As with Parkinsons, Lewy body dementia is associated with a depletion of certain neurotransmitters in the brain. These are:
- Dopamine: This neurotransmitter helps transmit signals that control muscle movement. When the accumulation of Lewy bodies blocks dopamines production and transmission, the result is the hallmark movement issues of Parkinsons disease.
- Acetylcholine: This neurotransmitter does its work in the parts of the brain responsible for memory, thinking and processing. When Lewy bodies build up in these areas, they interfere with acetylcholine, causing symptoms of dementia.
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Movement Thinking And Sleep Problems Are Common
There are two types of Lewy body dementia : dementia with Lewy bodies and Parkinson’s disease dementia. Dementia is a loss of mental functions that is severe enough to affect your daily life.
The main difference between the two is when the start of thinking and movement symptoms occur.
Dementia with Lewy bodies first causes problems with mental functioning similar to Alzheimer’s disease. Those can include feeling less alert, trouble focusing or doing everyday tasks, and memory loss. Unlike Alzheimer’s, it later causes certain movement issues, visual hallucinations, and sleep problems.
Parkinson’s disease dementia is a complication of Parkinsons disease. A person with Parkinson’s disease starts with symptoms like slowed movement, muscle stiffness, tremors, and a shuffling walk. Later, some people have a decline in mental functioning that becomes dementia.
People with the condition may not have every symptom in the early stages of LBD. If you believe you or a loved one has LBD symptoms, try to keep a running list of them to share with your health care provider.
: MedlinePlus National Institute on Aging
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Alzheimers Risk Factors And Alzheimers Disease Treatments
The greatest risk factor for developing Alzheimerâs is age, but genetics and family history also play a role. After age 65, the risk of Alzheimerâs doubles every five years. 32% of people age 85 and older have Alzheimerâs Disease.
Unfortunately, there is no medication or therapy available to prevent, treat or slow the progression of Alzheimerâs. But, there are FDA approved treatments that can address symptoms, that come in two primary forms:
- Cholinesterase Inhibitors to prevent the breakdown of acetylcholine which is important for memory.
- Glutamate Modulators: regulates glutamate activity which is important for information storage and retrieval.
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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
What Is Vascular Dementia
Vascular dementia is a type of dementia that is due to brain damage caused by problems in the blood vessels supplying blood to the brain. It is usually caused by brain damage from impaired blood flow to the brain. Reducing blood flow to the brain may decrease the amounts of nutrition and oxygen the brain needs to perform thought processes effectively. The common conditions that may lead to vascular dementia include stroke, brain hemorrhage, and narrowed or chronically damaged brain blood vessels. The risk factors that trigger this condition include increasing age , history of heart attacks, strokes, ministrokes, abnormal aging of blood vessels, high cholesterol, high blood pressure, diabetes, smoking, obesity, and atrial fibrillation.
Figure 02: Vascular Dementia
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What Is A Vascular Dementia
Vascular dementia is a type of dementia caused by brain lesions caused by problems in the blood vessels that provide brain blood. This is usually caused by brain lesions caused by blood flow to the brain. By reducing blood flow to the brain, a diet and the necessary oxygen can be effectively reduced. Frequent conditions that can lead to vascular dementia include stroke, brain bleeding and shrinkage of blood vessels or chronic damaged from the brain. Risk factors that cause this condition include increased age , a heart attack, paralysis, ministry, abnormal aging of blood vessels, high cholesterol, high blood pressure, diabetes, smoking, obesity and athial fibrillation.
How Is Lbd Different From Parkinsons Or Alzheimers
These diseases are similar in a lot of ways. But there are some key differences in the symptoms that affect people with LBD and when those symptoms happen.
LBD may not cause short-term memory loss like Alzheimerâs. People with both conditions have trouble with thinking, alertness, and paying attention. But in LBD, those problems come and go. The disease can also cause hallucinations, often in the first few years someone has LBD. People with Alzheimerâs usually donât have hallucinations until the later stages.
People with LBD also often act out their dreams and make violent movements when theyâre asleep. Itâs called REM sleep behavior disorder. Sometimes, itâs the first sign that someone has LBD.
LBD and Parkinsonâs disease both cause movement problems, like stiff muscles and tremors. But most people with Parkinsonâs donât have problems with their thinking and memory until the very later stages of their disease. Sometimes, they donât have it at all. In the type of LBD known as Parkinsonâs disease with dementia, these problems begin much sooner.
People with LBD also need different drugs for their condition than the ones that treat Parkinsonâs or Alzheimerâs.
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Memory And Thinking Problems
You may experience forgetfulness, slowed thinking and difficulty concentrating. You might find it harder to follow conversations, and remember some words and names. This can make communication difficult.
You may also find it increasingly difficult to make decisions, plan activities and solve problems. This can make everyday activities harder.
How Is Lewy Body Dementia Diagnosed
Diagnosing Lewy body dementia can be challenging. Early LBD symptoms are often confused with symptoms found in other brain or psychiatric conditions.
There are no medical tests that can diagnose Lewy body dementia with 100% accuracy. A diagnosis may require a group of specialists, including:
- Neuropsychologists.
Together, they can make the diagnosis of probable LBD based on the combined results of tests and symptoms.
Along with a history of progressive cognitive decline that interferes with daily activities, a diagnosis of LBD is considered probable if two of the following four core features are present and is considered possible if only one is present:
- Fluctuations in cognition and behavior.
- Recurrent visual hallucinations.
- Rapid eye movement sleep behavior disorder.
Some people with Parkinsons disease who develop cognitive symptoms less than a year after the onset of movement problems may be diagnosed with Lewy body dementia.
Healthcare providers use the following strategies to help diagnose LBD and to rule out conditions that cause similar symptoms:
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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 .