Is Lewy Body Dementia Present In All Parkinson’s Residents

What Causes Dementia With Lewy Bodies

Lewy bodies are named after the German doctor;who first identified them. They are tiny deposits;of a protein that appear in nerve;cells in the brain. Researchers don’t have a full;understanding of why Lewy bodies appear, or exactly;how they contribute to dementia. However, this is;linked to two factors:

• low levels of important chemicals that carry messages;between nerve cells
• a loss of connections between nerve cells, which;then die.

Lewy bodies are the cause of DLB and Parkinson’s;disease. They are two of several diseases caused by;Lewy bodies that affect the brain and nervous;system and get worse over time. These are;sometimes called Lewy body disorders.;

The way someone is affected by DLB will depend;partly on where the Lewy bodies are in the brain:;

• Lewy bodies at the base of the brain are closely;linked to problems with movement . These are the main feature of;Parkinson’s disease.
• Lewy bodies in the outer layers of the brain are;linked to problems with mental abilities , which is a feature of DLB.

People with a Lewy body disorder can have;problems with movement and changes in mental;abilities at the same time.

A person with Parkinson’s disease is at high risk of going on to develop dementia as their condition progresses. Dementia may be more likely in a person who has developed Parkinson’s later in life or who has been living with it for several years.

Understanding Lewy Body Dementias

Lewy body dementias affect an estimated 1.4 million individuals and their families in the United States. At the Lewy Body Dementia Association , we understand that though many families are affected by this disease, few individuals and medical professionals are aware of the symptoms, diagnostic criteria, or even that LBD exists. There are important facts about Lewy body dementias that you should know if you, a loved one, or a patient you are treating may have LBD.

Treatment Options For Lewy Body Dementia

Treatment for dementia with Lewy bodies is not easy because there is still no cure for the progressive disease. Most of the time, doctors will try and treat individual symptoms through a variety of options such as:

Medications

Certain medications can be prescribed to persons who have LBD. Research shows that persons who have this progressive illness are sensitive to medication.

It is; therefore, important for medications to be prescribed with caution and careful monitoring. Some of the drugs include:

Cholinesterase inhibitors

These are Alzheimers drugs like donepezil, rivastigmine, and galantamine. They are believed to help increase the levels of chemical messengers that are vital for memory, judgment, and thought in the brain.

It can help enhance cognition, alertness, and reduce hallucinations as well as other behavioral issues.

Parkinsons disease Drugs

Medications like carbidopa-levodopa might help to reduce some of the signs and symptoms of Parkinsons disease. These include slow movement and rigid muscles.

Medicine for other Symptoms

Physicians may also prescribe drugs that treat other symptoms associated with the progressive illness like movement or sleep issues. People who experience sleep disturbances can get melatonin and low-dose clonazepam.

Other drugs can be used to treat blood pressure and any other symptoms that a person may have.

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Symptoms Of Dementia With Lewy Bodies

People with dementia with Lewy bodies may have:

• hallucinations seeing, hearing or smelling things that are not there
• problems with understanding, thinking, memory and judgement this is similar to Alzheimers disease, although memory may be less affected in people with dementia with Lewy bodies
• confusion or sleepiness this can change over minutes or hours
• slow movement, stiff limbs and tremors
• disturbed sleep, often with violent movements and shouting out
• fainting spells, unsteadiness and falls

These problems can make daily activities increasingly difficult and someone with the condition may eventually be unable to look after themselves.

Coping With A Diagnosis

Being diagnosed with dementia can be an overwhelming experience. While there is no cure at present for LBD, or any medications aimed at specifically treating LBD, doctors are able to treat many of its symptoms. There are also a number of self-help strategies that can help improve symptoms.

If youve been diagnosed with LBD, its normal to feel many strong and painful emotions, including anger, fear, and uncertainty about the future.

Take time to adjust. As with any major life change, its important to give yourself time to adjust. Expect ups and downs as you do. You may feel that youve come to terms with your new situation for a while, and then suddenly feel overwhelmed by stress again.

Reach out for support.;Living with Lewy body dementia is not easy, but there is help for this journey. The more support you have from family and friends, the better youll be able to cope with symptoms.

Talk to your loved ones about your wishes. Its never easy to talk about how you want your healthcare handled when youre unable to make decisions for yourself. But its important to let your loved one know what is important to you. Thinking about your choices today can improve your quality of life in the future and ease the burden on your family.

Slowing the progression of symptoms

The same healthy lifestyle changes that are used to prevent dementia can also be useful in slowing the advancement of LBD symptoms.

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Lewy Body Masterclass: November 2021

There is an urgent need to address the gap in awareness and clinical skills around the diagnosis and management of LBD by clinicians in the UK and Ireland.

This MasterClass aims to address this gap by providing intense practical education regarding the diagnosis and practical management of LBD/PDD among clinicians in the UK and Ireland, leaning on the latest evidence regarding biomarkers and interventions. The MasterClass will also form the basis of developing a network of LBD-skilled clinicians across the UK and Ireland, able to lead improvements in diagnosis, management, and care.

Improving Diagnosis With Composite Scores

A diagnostic challenge, particularly outside of expert centers, there are long delays in diagnosing LBD leading to significant burden. Although consensus criteria have excellent specificity, there is no standardized way to assess symptoms, reducing sensitivity. We developed the LB Composite Risk Score 21 from autopsy-verified cases to improve the ability to detect LBD in clinic and research populations .

Figure. Diagnostic Tools for Dementia With Lewy Bodies. The Lewy Body Composite Risk Score is a 10-item questionnaire to capture signs and symptoms associated with Lewy body pathology. A score of 3 or greater represents a high probability that Lewy bodies are contributing to cognitive decline . Comparison of MRI in Alzheimers disease and dementia with Lewy bodies demonstrates less cortical and hippocampal atrophy in DLB . Comparison of dopamine transporter single photon emission tomography in AD and DLB shows decreased dopamine uptake in the basal ganglia in DLB vs normal uptake in AD.

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Lewy Bodies And Parkinsons Disease

A person with Parkinsons disease may develop dementia and have problems with reasoning and thinking. Lewy bodies are a feature of several brain disorders, including Parkinsons disease and Alzheimers disease, and they may cause rigid muscles and problems with movement and posture.

Research suggests that the similarity of the symptoms of Parkinsons disease and Lewy body dementia may be indicative of a shared link to how the brain processes alpha-synuclein.

It is not possible to test for the presence of Lewy bodies, so researchers must try to determine their effects by carrying out postmortem studies.

There is currently no cure for dementia. However, medication can alleviate the symptoms, while a team of medical professionals and therapists may help a person develop strategies to manage their daily activities.

Surgical Intervention For Patients With Lewy Body Dementia

Surgical interventions are a common area of concern for patients and caregivers. Dementia in and of itself, and a diagnosis of LBD in particular, does not preclude necessary surgical interventions. This can become more of a gray area when optional procedures such as knee or hip replacements are considered. Clearly, arthritic joints can severely limit QOL but there is a balance when considering potential repercussions from anesthesia and the rehabilitation potential with a pre-existing cognitive and functional impairment. The relationship between general anesthesia and LBD specifically has not been robustly examined. Patients with LBD may respond poorly to certain anesthetics and experience postoperative delirium and/or functional decline . Patients with Parkinsons disease need careful oversight of their drug dosing regimen so it is impacted as little as possible pre- and postoperatively . A discussion with both the surgeon and anesthesiologist prior to surgery about the LBD diagnosis is prudent.

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Lewy Body Dementia Research

Many avenues of research are being explored to improve our understanding of LBD. Some researchers are working to identify the specific differences in the brain between the two types of LBD. Others are looking at the disease’s underlying biology, genetics, and environmental risk factors. Still other scientists are trying to identify biomarkers , improve screening tests to aid diagnosis, and research new treatments.

Scientists hope that new knowledge about LBD will one day lead to more effective treatments and even ways to cure and prevent the disorder. Until then, researchers need volunteers with and without LBD for clinical studies.

NIH and other groups help people learn about clinical trials and studies and find research opportunities near them. Visit the following websites for details:

• Alzheimers.gov

Differences Between Pdd And Dlb

So, how are PDD and DLB different from each other? That depends on whom you ask. Some clinicians feel that these two conditions are simply different versions of the same disorder. In fact, some professionals use the terms interchangeably. Yet, according to currently agreed-upon diagnostic guidelines, there are some differences.

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Whats The Difference Between Lewy Body Dementia Parkinsons Disease And Alzheimers Disease

Lewy body dementia is an umbrella term for two related clinical diagnoses: dementia with Lewy bodies and Parkinsons disease dementia. These disorders share the same underlying changes in the brain and very similar symptoms, but the symptoms appear in a different order depending;on where the Lewy bodies first form.

Dementia with Lewy bodies is a type of dementia that causes problems with memory and thinking abilities that are severe enough to interfere with everyday activities. It specifically affects a persons ability to plan and solve problems, called executive function, and their ability to understand visual information. Dementia always appears first in DLB. The motor symptoms of Parkinsons such as tremor, slowness, stiffness and walking/balance/gait problems usually become more evident as the disease progresses. Visual hallucinations, REM sleep behavior disorder, fluctuating levels of alertness and attention, mood changes and autonomic dysfunction are also characteristic of DLB.

Finally, Alzheimers is characterized by different abnormal clumps called amyloid plaques, and jumbled fiber bundles called tau tangles. These microscopic structural changes in the brain were discovered by Dr. Alois Alzheimer in 1906. These plaques and tangles, together with loss of connections between nerve cells, contribute to loss of coherence and memory, as well as a progressive impairment in conducting normal activities of daily living.

Causes Of Lewy Body Dementia

The origin of dementia with Lewy bodies has not yet been identified. Hallmarks for dementia with Lewy bodies include an abnormal build-up of proteins. These proteins are known as Lewy bodies. They are the same proteins that are associated with Parkisons disease, another type of dementia.

Persons with Lewy bodies also have tangles and plaques that are linked with Alzheimers in their brains. Experts are not sure what causes the build-up of proteins. A majority of individuals who have Lewy bodies do not have a family history of the illness.

To date, scientists have not identified a genetic cause.

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Causes And Risk Factors

Although we know that changes in the brain cause Lewy body dementia, we dont know what triggers those changes. Variations in three genes have been linked to the disease, but the connection is not clear. At present, its not considered a genetic disease.

The risk of developing LBD increases with age. Men are slightly more likely to have it than women. Having someone in your family with LBD can increase your chances of developing it.

What Are The Stages Of Dementia

The stages of dementia vary from person to person and the type of dementia. Keeping the four common types of dementia in mind, these seven stages are the usual progression that is experienced:

• No symptoms yet, but tests might reveal a problem
• Very mild changes in behavior, but independence remains
• Mild decline is noticeable, including changes in thinking, forgetting events, and repeating statements
• Moderate decline, meaning trouble remembering recent events and handling money
• A moderate to severe decline where they forget names, are unsure what time of day it is, and need some assistance with basic daily tasks
• Their decline is severe they are forgetting their spouses name, their personality is changing, and they need help eating and going to the bathroom
• Very severe decline, where they are unable to walk, can no longer speak their thoughts, and spend most time in bed

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Stages Of Lewy Body Dementia

LBD can be distinguished by 3 stages as described below.

Early Stages

The earlier stages of dementia with Lewy bodies usually involve hallucinations and other reality distortions such as restlessness, delusions, some movement difficulties, and acting out dreams when a person is sleeping.

Some people will appear to get stuck or freeze when moving around. Although rare, some individuals will also develop incontinence and urinary urgency during this stage. Some mild cognitive changes and confusion may also be present.

Middle Stages

As the illness progresses to the middle stages, the symptoms a person experiences begin to resemble those that exist in Parkinsons disease.

These include increased body motor function impairment, frequent falls, challenges with speech, more pronounced delusions and paranoia, and difficulties when swallowing.

Cognition will also continue to decline to include long periods of confusion and decreased attention.

Later Stages

During the later stages of this illness, a person may experience extreme sensitivity to touch and muscle rigidity.

Speech also becomes challenging where it may be absent or a person will communicate with whispers. At this point, care becomes necessary for daily living activities.

Signs And Symptoms Of Lewy Body Dementia

In the early stages of LBD , symptoms can be mild allowing individuals to function normally. As the disease worsens, cognitive and movement difficulties cause individuals to need more and more assistance. As the disease moves into the later stages, individuals may depend upon others entirely to provide for their needs.

Patterns of symptoms typically manifest in four ways:

• Neuropsychiatric symptoms including behavioral problems, hallucinations and trouble with complex mental tasks
• Cognitive problems and memory loss
• Physical symptoms such as balance issues, motor problems, shuffling gait and tremors
• Changes in attention and alertness

Cognitive symptoms tend to manifest earlier with LBD than with Parkinsons disease dementia.

Hallucinations may be one of the first symptoms to appear and may be recurrent. Hallucinations tend to be detailed and very well formed.

Cognitive issues similar to those of Alzheimers occur, such as memory loss, confusion, visual-spatial problems and poor attention . Individuals may stare into space for long periods of time and experience disorganized speech.

Movement symptoms occur, although some individuals with LBD may not experience them for several years following diagnosis. Initially, small movement issues happen that are often overlooked, such as a change in handwriting. Parkinsonism is experienced early in the disease process with Parkinsons disease dementia. These specific Parkinsonism symptoms may include:

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Managing Sleep Disorders In Lewy Body Dementia

Sleep problems may increase confusion and behavioral problems in people with LBD and add to a caregiver’s burden. A physician can order a sleep study to identify any underlying sleep disorders such as sleep apnea, restless leg syndrome, and REM sleep behavior disorder.

REM sleep behavior disorder, a common LBD symptom, involves acting out one’s dreams, leading to lost sleep and even injuries to individuals and their sleep partners. Clonazepam, a drug used to control seizures and relieve panic attacks, is often effective for the disorder at very low dosages. However, it can have side effects such as dizziness, unsteadiness, and problems with thinking. Melatonin, a naturally occurring hormone used to treat insomnia, may also offer some benefit when taken alone or with clonazepam.

Excessive daytime sleepiness is also common in LBD. If it is severe, a sleep specialist may prescribe a stimulant to help the person stay awake during the day.

Some people with LBD have difficulty falling asleep. If trouble sleeping at night persists, a physician may recommend a prescription medication. It is important to note that treating insomnia and other sleep problems in people with LBD has not been extensively studied, and that treatments may worsen daytime sleepiness and should be used with caution. Sleep problems can also be addressed by avoiding lengthy naps, increasing daytime exercise, and avoiding caffeine, alcohol, and chocolate late in the day.