Causes Of Dementia With Lewy Bodies
Dementia with Lewy bodies is caused by clumps of protein forming inside brain cells. These abnormal deposits are called Lewy bodies.
These deposits are also found in people with Parkinson’s disease, and they build up in areas of the brain responsible for functions such as thinking, visual perception and muscle movement.
It’s not clear why the deposits develop and how exactly they damage the brain. It’s thought that part of the problem is the proteins affecting the brain’s normal functions by interfering with signals sent between brain cells.
Dementia with Lewy bodies usually occurs in people with no family history of the condition, although there have been very rare cases that seem to run in families.
Dementia Progresses At Different Rates For Different People
Dementia is, unfortunately, progressive but, like the motor features of MD, progresses at very different rates in different people. It not only causes poor memory and thinking, but also is frequently associated with depression, sleep disorders, loss of motivation, loss of interest and pleasure in activities that had previously enriched or even defined their life. Patients with dementia are often apathetic, showing reduced happiness and unhappiness. They are more likely to develop problems with sleeping too much or developing challenging sleep habits brings with it an increased sensitivity to the side effects of all the drugs used in treating Parkinsons Disease itself. People with dementia are more likely to develop hallucinations or confusion. Therefore the motor problems of Parkinsons Disease cannot be treated as aggressively in a patient with dementia as compared to the patient without dementia.
Dementia does not kill people. It is not a death sentence. It is true that dementia is associated with a reduced life expectancy, but this is likely due to the greater difficulty involved in treating the motor problems of PD. As noted above, this is because of the increased likelihood of drug side effects in patients with dementia. Unfortunately, more bad things happen to people with dementia. They may forget to use their cane or walker, increasing the risk of falls. They may take their medications unreliably or incorrectly or ignore warning signs of other medical problems.
Things You Should Know About The Link Between Parkinsons And Dementia
Both Parkinsons disease and dementia were ravaging the brain and behavior of actor Robin Williams before his death, but at the time, he didnt realize he had the latter.
Despite the fact that the signs of this combination can be confusing, the double diagnosis of Parkinsons and dementia impacts a large number of people. Of the one million people who have Parkinsons in the U.S., 50 to 80 percent may have dementiaeither as a result of Parkinsons pathology, or separately.
Robin Williams widow, Susan, wrote an editorial published in Neurology that was addressed to neurologists after his death. In it, she shared what it was like seeing her husband experience both Parkinsons disease and Lewy body dementia firsthand.
My hope is that it will help you understand your patients along with their spouses and caregivers a little more, Susan wrote.
Williams was first diagnosed with Parkinsons disease, which at first seemed to provide some answers for his out-of-character symptoms.
But it wasnt until after his death that an autopsy revealed he had been in the later stages of Lewy body dementiaa common form of dementia characterized by deposits of Lewy body proteins in the brain, which can impact physical movement, mood, memory and behavior.
I will never know the true depth of his suffering, nor just how hard he was fighting, Susan wrote. But from where I stood, I saw the bravest man in the world playing the hardest role of his life.
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Delusions From Parkinsons Disease
Delusions affect only about 8 percent of people living with PD. Delusions can be more complex than hallucinations. They may be more difficult to treat.
Delusions often start as confusion that develops into clear ideas that arent based on reality. Examples of the types of delusions people with PD experience include:
- Jealousy or possessiveness. The person believes someone in their life is being unfaithful or disloyal.
- Persecutory. They believe that someone is out to get them or harm them in some way.
- Somatic. They believe they have an injury or other medical problem.
- Guilt. The person with PD has feelings of guilt not based in real behaviors or actions.
- Mixed delusions. They experience multiple types of delusions.
Paranoia, jealousy, and persecution are the most commonly reported delusions. They can pose a safety risk to caregivers and to the person with PD themselves.
PD isnt fatal, though complications from the disease can contribute to a shorter expected life span.
Dementia and other psychosis symptoms like hallucinations and delusions do contribute to increased hospitalizations and increased rates of death .
One study from 2010 found that people with PD who experienced delusions, hallucinations, or other psychosis symptoms were about 50 percent more likely to die early than those without these symptoms.
But early prevention of the development of psychosis symptoms may help increase life expectancy in people with PD.
How Parkinsons And Alzheimers Affect The Body And Brain Differently
Alzheimers and Parkinsons are both neurological illnesses. Both diseases are caused by damaged brain cells. Both conditions can involve dementia, as well as depression, anxiety, and sleep disturbances. Both conditions can lead to psychotic symptoms such as delusions and hallucinations.
While Alzheimers and Parkinsons share certain causes and effects, the two diseases are different. They impact the brain and progress in different ways. Both disorders affect people differently, manifest themselves differently, and progress at different rates.
I had a father with Parkinsons and a mother with dementia. My experience was that the Parkinsons progressed at a slower rate and was more motor-related than mental.
My father experienced tremors, as well as changes in his walking and facial expressions. But his cognitive ability was relatively intact up to the very last stages of the disease. My mothers dementia made her feeble and uncertain on her feet, but she remained active and mobile, even as her cognitive ability declined.
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Understanding How This Dementia Differs From Alzheimers Can Help Patients Know What To Expect And Feel Less Fearful
En español | Many symptoms of Parkinsons disease shuffling gait, quivering hands, stooped posture are easy to spot. But this disease can also cause problems that are far less visible but no less distressing. Perhaps the most worrisome is cognitive decline, which affects about 50 percent of patients.
This is a scary, confusing and concerning topic for a lot of people, says neurologist Rachel Dolhun, M.D., senior vice president of medical communications at the Michael J. Fox Foundation. While these feelings are natural, common misconceptions can exacerbate patients fears.
For starters, cognitive decline doesnt necessarily equal full-blown dementia, and many people with Parkinsons develop only mild impairment. Another misconception is that even slight memory slippage signals that rapid deterioration is imminent but thats far more common with Alzheimers disease than it is with Parkinsons, says Tsao-Wei Liang, M.D., chief of the movement disorders division at Jefferson Health. Its not always relentlessly progressive, and more often than not, symptoms can be managed with medication, caregiver support and basic organizational strategies, he says.
Its also important to know that many Parkinsons patients with some cognitive impairments are able to form new short-term memories, even if they struggle with attention and multitasking. People with Parkinsons will often remember if you give a clue or prompt them, Dolhun says.
Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
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The 5 Stages Of Parkinsons Disease
Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.
Dementia With Lewy Bodies
A less common type of dementia can also affect those with Parkinsons. This is called Dementia with Lewy bodies. It is different from the classic Parkinsons Dementia because dementia comes on at the same time as the movement problems like tremor, stiffness and slowness. On occasion, dementia can actually develop without any other symptoms or signs.
Like Alzheimers and Parkinsons Dementia, Dementia with Lewy bodies causes memory loss, problems with language and impaired concentration. It can also affect the ability to recognise faces, perform simple actions and to judge distances and movements.Vivid visual hallucinations, are particularly common in this type of dementia and can start fairly early on in the disease.
Although there is still no cure for Parkinsons or the dementia associated with the disease, the symptoms may be eased a little with medications and specialist therapies. So, it is important to get advice from your GP, specialist or Parkinson’s nurse if you are worried, or if you are experiencing problems with your memory.
Life with dementia can be challenging, but getting treatment and support early may improve symptoms and help you maintain your independence, function and wellbeing for longer. With the right care and disease control you really can continue to love, laugh and live with Parkinsons.
Find out more about Parkinsons disease:
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Preventing And Delaying Cognitive Change
To overcome the cognitive changes linked to Parkinsons, it is recommended that you keep as active and stimulated as possible – physically, mentally and socially. It is important to stimulate all the different parts of the brain. Some useful tips include:
- Undertake regular exercise
- Complete simple arithmetic and crosswords
- Listen to and play music
- Participate in a social group
- Do volunteer work
- Maintain paid employment if possible
- Learn new skills
Coping With Dietary Problems
Many people with Parkinsons experience various eating and dietary problems, such as constipation, chewing and swallowing difficulties, and upset stomach. The following tips can help you minimize the symptoms.
If you suffer from constipation Drink lots of water and eat fiber-rich foods, including beans, brown rice, whole grains, and fruit.
If you have trouble chewing or swallowing food Cut foods into smaller portions to avoid choking and to encourage digestion, and remain upright for 30 minutes after eating.
If youre struggling with fatigueLimit the amount of sugar youre eating. Also avoid alcohol and caffeine, especially before bed, as they can reduce the quality of your sleep.
If you take levodopa Dont eat meat or other protein-rich foods for at least 30-60 minutes after taking levodopa, as protein blocks your bodys ability to absorb the medication.
If your medication gives you an upset stomach Take your medication with a full glass of water and a small non-protein based snack, such as a piece of toast or fruit.
Some Parkinsons disease medications need to be taken promptly at specified times before or after eating, so it can also help to establish a regular routine for meal and medication times.
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Medications To Help Treat Parkinsons Disease Psychosis
Your doctor might consider prescribing an antipsychotic drug if reducing your PD medication doesnt help manage this side effect.
Antipsychotic drugs should be used with extreme caution in people with PD. They may cause serious side effects and can even make hallucinations and delusions worse.
Common antipsychotic drugs like olanzapine might improve hallucinations, but they often result in worsening PD motor symptoms.
Clozapine and quetiapine are two other antipsychotic drugs that doctors often prescribe at low doses to treat PD psychosis. However, there are concerns about their safety and effectiveness.
In 2016, the approved the first medication specifically for use in PD psychosis: pimavanserin .
In clinical studies , pimavanserin was shown to decrease the frequency and severity of hallucinations and delusions without worsening the primary motor symptoms of PD.
The medication shouldnt be used in people with dementia-related psychosis due to an increased risk of death.
Psychosis symptoms caused by delirium may improve once the underlying condition is treated.
There are several reasons someone with PD might experience delusions or hallucinations.
Management Of Dementia In Parkinsonism
There is some evidence that cholinesterase inhibitors may have antipsychotic properties for the management of behavioral symptoms in Parkinsonism. A number of open-label studies have documented the beneficial effects of donepezil and rivastigmine in the management of dementia in Parkinsonism. A large placebo-controlled study of rivastigmine found that the rivastigmine group had significant improvement of the neuropsychiatric symptoms than the control group and were less likely to develop hallucinations. Furthermore, patients who suffered from visual hallucination at the time of initiation of treatment benefited the most.
The management of psychosis in DLB is equally frustrating and only a prospective randomized study in this regard has been reported to date. Rivastigmine led to significant improvement in delusions, hallucinations, depression, and apathy and therefore, cholinesterase inhibitors are now recommended as the first line of management for this condition. Mementine has also been found useful in one small retrospective study. However, cholinesterase inhibitors can increase tremor in Parkinsonism by their procholinergic actions.
One of the major problems of management of psychosis and related problems in Parkinsonism is that stopping drugs often lead to worsening of symptoms. However, some trials show that patients can be switched from clozapine to quetiapine after stability has been earned, provided they responded earlier to the latter agent.
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Symptoms Of Cognitive Change
The cognitive changes experienced by people with Parkinsons vary from person to person. Possible cognitive symptoms linked with early-stage Parkinsons include:
- Difficulty multi-tasking
- Difficulty concentrating and becoming easily distracted
- Difficulty learning new skills
- Difficulty remembering certain things
As Parkinsons progresses these symptoms can worsen and new symptoms might appear. Possible impairments later in the course of the condition might include:
- Difficulty with problem-solving
- Difficulty judging distances and directions
Understanding How This Dementia Differs From Alzheimer’s Can Help Patients Know What To Expect And Feel Less Fearful
by Barbara Brody, AARP, April 6, 2021
En español | Many symptoms of Parkinson’s disease shuffling gait, quivering hands, stooped posture are easy to spot. But this disease can also cause problems that are far less visible but no less distressing. Perhaps the most worrisome is cognitive decline, which affects about 50 percent of patients.
“This is a scary, confusing and concerning topic for a lot of people, says neurologist Rachel Dolhun, M.D., senior vice president of medical communications at the Michael J. Fox Foundation. While these feelings are natural, common misconceptions can exacerbate patients fears.
For starters, cognitive decline doesn’t necessarily equal full-blown dementia, and many people with Parkinson’s develop only mild impairment. Another misconception is that even slight memory slippage signals that rapid deterioration is imminent but that’s far more common with Alzheimer’s disease than it is with Parkinson’s, says Tsao-Wei Liang, M.D., chief of the movement disorders division at Jefferson Health. It’s not always relentlessly progressive, and more often than not, symptoms can be managed with medication, caregiver support and basic organizational strategies, he says.
It’s also important to know that many Parkinson’s patients with some cognitive impairments are able to form new short-term memories, even if they struggle with attention and multitasking. People with Parkinson’s will often remember if you give a clue or prompt them, Dolhun says.
Treating Parkinsons Disease Dementia
A treatment plan for PDD typically includes medications that boost the brains level of certain neurotransmitters and help improve memory and processing speed, Dr. Petrossian says. Exercise is also an important part of the treatment planDr. Petrossian recommends skill-based activities like boxing or dance to boost cognitive function as well as fitness. PDD symptoms should be monitored long-term by a neurologist, and in some cases a psychiatrist, says Dr. Okun. In many cases, physical, occupational, speech, and social work therapy can also be useful since PPD affects all aspects of life.
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Parkinsons Disease Dementia Surgery And Gene Therapy
- Great strides have been made in the surgical treatment of Parkinsons disease. Several different procedures are now available, and they are successful in many patients in relieving movement symptoms. Unfortunately, surgery has no effect on cognitive symptoms. In fact, most people with dementia are not candidates for surgery.
- Gene therapy is in its infancy there are ongoing human and animal trials with various methods to insert genes into neuronal cells to reduce or stop Parkinsons disease symptoms by causing cells to produce dopamine coded by the newly inserted genes. Early results with the treatment termed ProSavin are encouraging. However, it is not clear if such therapy could prevent or reverse Parkinsons disease dementia.