Psychosis: Hallucinations And Delusions
Hallucinations describe perceptions of the five senses that seem real, yet are falsely created by the mind. Delusions are false beliefs based on the alteration of reality. Someone who is delusional accepts false beliefs as true regardless of contradictory evidence. Both are considered psychosis.
The beginning symptoms manifest as hallucinations and delusions. A study in Parkinsonism and Related Disorders found that hallucinations recur early in the diagnosis. Visual hallucinations like seeing animals and people are the most common. For example, hallucinating spiders crawling on the wall, and a delusion that claims something is out to get me are each noted in patients.
How Is Lewy Body Disease Diagnosed
This type of dementia is diagnosed by taking a careful history of the pattern of symptoms, and by excluding other possible causes such as Vascular dementia and Alzheimer’s disease. A brain scan may reveal brain degeneration, but the Lewy bodies can only be identified by examination of brain tissue after death.
Lewy body disease is similar to Alzheimer’s disease in many ways, and in the past it has sometimes been difficult to distinguish the two. It has only recently been accepted as a disease in its own right. It can occur by itself or together with Alzheimer’s disease and/or Vascular dementia. It may be hard to distinguish Lewy body disease from Parkinson’s disease, and some people with Parkinson’s disease develop a dementia which is similar to that seen in Lewy body disease.
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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Treatment Of Autonomic Dysfunction
This is an uncomfortable, under-recognized and poorly treated feature of synucleinopathy: 8089 % of PD patients report constipation and/or diarrhea, and 16 % have been hospitalized for bowel obstruction . Although most cases of constipation are secondary to decreased colonic transit and gastrointestinal dysmotility, anorectal dysfunction may contribute significantly in a small set of subjects. Gastrointestinal specialist involvement is important in cases of refractory symptoms.
A high-fiber diet combined with adequate hydration, regular exercise and stool softeners is often effective and should be the first step in treatment.
When pharmacological interventions are needed, osmotic agents are preferred over prokinetic agents: they have fewer side effects with long-term use.
Psyllium and polyethylene glycol are effective .
Alternatives include methylcellulose, docusate, magnesium hydroxide, and misoprostol .
A recent double-blind, 4-week study found significant improvement with the use of the chloride channel activating agent lubiprostone .
Lewy Body Dementia Root Causes & Risk Factors
The exact cause of Lewy body dementia is still unknown, but researchers continue to study and try to figure out this complex disease. We do know that an accumulation of abnormal protein deposits in the brain, or Lewy bodies, are associated with a loss of certain neurons that produce two important neurotransmitters, acetylcholine and dopamine. Acetylcholine is key to the brains ability to remember and learn things while dopamine plays a crucial role in behavior, cognition, movement, motivation, mood and sleep.
Although the cause of Lewy body dementia isnt clear, several factors appear to increase the risk of developing the disease. They include:
- Age Being older than 50. Age is considered the greatest risk factor.
- Gender Being male. Slightly more men than woman have LBD.
- Genetics Having a family member with Lewy body dementia, but LBD is not normally considered a genetic disease. A small percentage of families with dementia with Lewy bodies has a genetic association with the disease. In some cases, its a variant of the GBA gene, but in most cases, the cause is unknown. Currently there is no genetic test that can accurately predict whether someone will develop LBD.
- Other diseases Having Parkinsons disease or REM sleep behavior disorder is linked to a higher risk of LBD.
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Lewy Body Dementia Research Efforts
Research for Lewy body dementia is ongoing. Current research focuses on the biological and genetic roots of LBD, alpha-synuclein protein accumulation, and how Lewy bodies cause symptoms of dementia. The goal is to find better ways to prevent, diagnose, and treat the different forms of dementia.
The 2022 American Brain Foundation Cure One Cure Many Award seeks to support scientists in the search for a biomarker, or clear indicator of the presence of the disease. Establishing a diagnostic test for LBD would not only enable individuals to receive a definitive diagnosis but would also support patient care and lead to new therapies. Discoveries for Lewy body dementia will likely also benefit research for related neurodegenerative diseases like Alzheimers disease and Parkinsons disease in the areas of diagnosis, treatment, and patient care.
Exposure To Medications And Serious Adverse Events
As discussed, there may be a delay in timely diagnosis of LBD so patients with behavioral manifestations may inadvertently be treated with a typical neuroleptic or atypical neuroleptic with D2 receptor antagonism, which can worsen parkinsonism, and exacerbate other features such as sedation and orthostatic hypotension . The greatest concern with the use of typical neuroleptics is neuroleptic malignant syndrome , which may be fatal. NMS is caused by central blockade of dopamine and includes muscle rigidity, hyperthermia, and autonomic instability. It can also occur from certain anti-emetics such as metoclopramide . While NMS is perhaps the most serious side effect, a similar but more common adverse reaction, neuroleptic sensitivity reactions, can be seen in DLB, PD, and PDD. Neuroleptic sensitivity reactions, which can occur in 30 to 50% of DLB patients, include sedation, increased confusion, rigidity, and immobility that may occur after taking a neuroleptic medication. They are just as likely to occur in patients with mixed pathology including AD, supporting the need for accurate diagnosis .
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Risk Factors For Lewy Body Dementia
There are only a few risk factors associated with Lewy body dementia including:
- Age people over the age of 60 are at higher risk of developing Lewy body dementia.
- Gender men are more likely to develop Lewy body dementia.
- Family history if you have a family history of Lewy body dementia, you are more likely to develop the condition as well.
- Depression early research studies show a link between depression and Lewy body dementia
Can Imaging Tests Diagnose Lewy Body Dementia
Imaging tests, such as computed tomography or magnetic resonance imaging , are done to rule out other causes of dementia such as brain tumors, brain bleeds, stroke, hydrocephalus or other structural causes. Imaging studies for Lewy body dementia are usually normal. The only way to make an absolute diagnosis of LBD is by examining the brain at autopsy.
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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.
What Are The Treatments For Lewy Body Dementia
Unfortunately, there is no curative treatment at this time. However, there are solutions to help control some of the symptoms of this neurodegenerative disease.
- Alzheimers disease medications are used to control some of the cognitive symptoms. They can help with memory and even reduce hallucinations.
- Parkinsons disease medication is helpful to reduce parkinsonian symptoms such as tremor and stiffness.
- Antipsychotics may also be prescribed by the physician for the treatment of delusions and hallucinations, for example. However, they should be used with caution as some of these drugs may amplify the symptoms.
All of these treatments require a prescription from the doctor. Our recommendation is to take the time to talk about this with the health care professional of your elderly relative. This way, it will be possible to choose what is most relevant for the well-being of the person.
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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:
What Are The Symptoms Of Lewy Body Dementia
Lewy body dementia symptoms may resemble those of other neurological disorders, like Alzheimers disease and Parkinsons disease. LBD affects each person differently, and symptoms vary in severity.
Common symptoms of LBD include:
- Visual hallucinations, or seeing things that are not there.
- Reduced alertness, attention and ability to concentrate.
- Parkinsonism, a movement disorder with symptoms including slowness, tremors, stiffness, balance problems, soft voice, difficulty swallowing, reduced facial expression and shuffling walk.
- Visuospatial difficulties, including decreased depth perception, trouble recognizing familiar objects and impaired hand-eye coordination.
- Delusions, or beliefs with no basis in reality.
- Changes in behavior and mood including anxiety, agitation, aggression, apathy, depression and paranoia.
- Changes in sleep patterns.
Other symptoms include:
- Acting out while sleeping. Your loved one may act out their dreams during a phase of sleep cycle called rapid eye movement . Sometimes this happens years before their LBD diagnosis. Often called REM sleep behavior disorder , this condition is described as frequent movements, such as flailing or punching, with yelling or speaking while sleeping. People living with RBD often have difficulty separating dreams from reality when they wake up.
- Changes in normal body functions. Body temperature may waver, blood pressure may fluctuate and loss of bowel and bladder control.
Health Brain And Neuroscience
Have you heard of Lewy body dementia? Probably not. I was unaware of this neurological disorder myself until a doctor said those life-changing words to my grandfather. They say its the worst of Parkinsons and Alzheimers disease. Although it is the most common type of progressive dementia amongst the general population, its symptoms go undiagnosed. Read further for more information on how Lewy body dementia affects the body and mind.
What Are The Symptoms
The symptoms of dementia with Lewy body disease include:
- Difficulty with concentration and attention
- Extreme confusion
- Difficulties judging distances, often resulting in falls.
There are also three cardinal symptoms, two of which must be present in order to make the diagnosis:
- Visual hallucinations
- Fluctuation in mental state so that the person may be lucid and clear at one time and confused, disoriented and bewildered at other times. Typically this fluctuation occurs over a period of hours or even minutes and is not due to any underlying acute physical illness.
Some people who have Lewy body disease may also experience delusions and/or depression.
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Lewy Body Dementia Treatment
Though Lewy body dementia is the second most common form of dementia , conventional treatment often fails to improve or soften the symptoms of LBD, and some patients get worse with recommended treatments. If youve been diagnosed with LBD, you may have been told there is nothing you can do. Well we disagree!
In a medical environment where medications have become the primary or default treatment for acute and chronic illnesses, patients are often left with little hope. When medicine is used as the only intervention for LBD, individuals often experience a steady decline in both brain and body health. Does this sound familiar? Are you getting physically weaker or do you struggle with parkinsonism? Have you experienced crushing depression or the yoyo-ing brain fog and debilitating confusion? Are you a poor sleeper and experience awful fatigue? If you are a caregiver for someone with LBD, are they experiencing intermittent hallucinations and psychosis? If you answer a resounding yes to any of these questions, then we may have some ideas to optimize your approach!
When your doctor said there was no treatment for LBD, what may have been a more accurate statement is there arent great medications that treat LBD. That is an accurate statement! In a recent review of the medical literature, we identified the most up-to-date treatment recommendations for Lewy body dementia. They are as follows:
Causes Of Lewy Body Dementia
Professionals are uncertain of the exact cause of Lewy body dementia. There are a few risk factors linked to the development of the disorder. Males over the age of 60 are diagnosed with it more than females. No lifestyle factors have been confirmed as a cause.
Family history is the greatest risk factor. Those who have a family member with Lewy body dementia or Parkinsons disease dementia are susceptible. Mutations in the APOE, SNCA, and GBA genes indicate the potential for acquiring Lewy body dementia, but it is not normally a genetic condition.
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How Exactly Is Lewy Body Dementia Related To Alzheimers Disease And Parkinsons Disease
Lewy body dementia is a broad, general term for dementia in which lewy bodies are present in the brain. Dementia with lewy bodies and Parkinsons disease dementia are two related clinical disorders that make up the general broader category of Lewy body dementia. Sometimes LBD is first diagnosed as Parkinsons disease or Alzheimers disease based on its symptoms.
- Parkinsons disease dementia : You might be diagnosed with Parkinsons disease if you start out with a movement disorder typical to Parkinsons but then have your diagnosis changed to PDD when dementia symptoms develop.
- Alzheimers disease : You might start out with memory or cognitive disorder that leads to a diagnosis of AD. Over time, other distinctive symptoms begin to appear and your diagnosis is then changed to dementia with lewy bodies. Distinctive symptoms of LBD include the changes in attention, alertness and cognitive ability changes in walking and movement visual hallucinations REM sleep behavior disorder and severe sensitivity to some antipsychotics used to treat hallucinations.
What Complications Are Associated With Medications Used To Treat Lewy Body Dementia
Up to 50% of people living with Lewy body dementia can have severe side effects when treated with certain antipsychotic medications. These are known as the typical or traditional antipsychotics and include such drugs as thoridazine, haloperidol, chlorpromazine and perphenazine. This class of older, first-generation antipsychotics can cause sedation and make cognitive symptoms and movement problems worse. A life-threatening reaction to an antipsychotic medication, called neuroleptic malignant syndrome, is possible. Symptoms include rigid muscles, changing blood pressure, high fever, confusion and fast heart rate. Contact your healthcare provider immediately if you or your loved are taking an antipsychotic and develop these symptoms.
Visual hallucinations and behavioral changes may be treated with the newer, atypical antipsychotic medications pimavanserin , quetiapine or clozapine . However, because all antipsychotic medications both older, typical medications and newer atypical medications can increase the risk of death in elderly patients with dementia, you and your healthcare provider should carefully discuss the risks and benefits and using these medications.
Other medications, like antidepressants or sedative antihistamines, may increase confusion in people with LBD.
Strange And Confusing Symptoms
Johns symptoms began in 2000, soon after surgery to remove his thyroid.
Because hed just had an operation, his doctors chalked some symptoms up to hormone imbalances related to the glands removal.
But in retrospect, said Snyder, the symptoms of LBD started long before his surgery about 20 years before.
Like many people with LBD, John developed REM sleep behavior disorder, a condition in which sleep becomes violent and disruptive.
His sleeping body began acting out the fantastical dreams he was having like being a pirate in a sword fight on a ship, or a fleeing soldier in a world war and the sleep-movements would knock him out of bed.
Other times he would laugh in his sleep.
As the disease progressed, Johns body stiffened up, and he began walking with a shuffle.
The highly intelligent, inquisitive trial lawyer started off his days sharp as a tack and would end them lost in a foggy confusion, Snyder said.
He started to withdraw from family gatherings, sitting alone in a chair when previously he would have been right in the middle of the party.
The scariest moment for Snyder came when John called police to deal with a bear on their property.
It turned out to be a tree stump.
Thats when I had a meltdown, Snyder recalled. I was like, Oh my goodness, youre working with these police and telling them you saw a bear, and theres no bear!’