What Are The Causes Of Lewy Body Dementia
The precise cause of LBD is unknown, but scientists are learning more about its biology and genetics. For example, we know that an accumulation of Lewy bodies is associated with a loss of certain neurons in the brain that produce two important chemicals that act as messengers between brain cells . One of these messengers, acetylcholine, is important for memory and learning. The other, dopamine, plays an important role in behavior, cognition, movement, motivation, sleep, and mood.
Scientists are also learning about risk factors for LBD. A risk factor is something that may increase the chance of developing a disease. Some risk factors can be controlled while others cannot. Age is considered the greatest risk factor. No specific lifestyle factor has been proven to increase one’s risk for LBD.
Other known risk factors for LBD include certain diseases and health conditions, particularly Parkinson’s disease and REM sleep behavior disorder, which have been linked to a higher risk of LBD.
Having a family member with LBD also may increase a person’s risk, though LBD is not considered a genetic disease. Variants in three genes APOE, SNCA, and GBA have been associated with an increased risk, but in most cases, the cause is unknown.
Preparing Lbd Families About End Of Life
End of life factors are known to be different in LBD compared to Alzheimers disease. The progression of LBD averages 5-7 years from onset to end of life. This is considerably shorter than the 8-10 years in Alzheimers disease. Adding typically-delayed diagnosis, this results in a compressed time to address LBDs complex diagnostic, clinical and caregiving issues.
A new study highlights that Lewy body dementia families need better guidance from their healthcare professionals on end of life issues. This includes likely causes of death, timing of engaging hospice services, and what to expect at end of life.
Led by Melissa Armstrong, MD, MSc of the University of FL, Gainesville, researchers explored the end of life experiences in people with one form of LBD: dementia with Lewy bodies . The study, a collaboration with the Lewy Body Dementia Association, used an online survey about end of life experiences.
The study included caregivers, family members and friends of people who died within the previous 5 years with a DLB diagnosis. Of the 658 respondents, most were female with a median age of 50-69. The study revealed most care recipients died within 5 years of their diagnosis.
Caregivers indicated providers rarely addressed what to expect at end of life . Most conversations on end of life issues were first broached by the caregiver.
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Frontotemporal Dementia: Early Symptoms Vary
In contrast to Alzheimers, people at the early stages of frontotemporal disorders generally dont have trouble with short-term memory. But depending on the type of frontotemporal issue, early symptoms may vary.
For the type of frontotemporal disorder that initially affects the part of the brain that controls behavior, people may behave rudely or appear oblivious to social norms, seem easily distracted, or appear uncharacteristically selfish or unfeeling.
For the less-common type of frontotemporal disorder that initially affects the part of the brain that controls language skills, the early stage includes trouble attaching names to things, comprehending words, or speaking fluently.
But as dementia becomes progressively worse, people who are experiencing behavior changes will begin having language difficulty, and vice versa.
As frontotemporal disorders progress, symptoms will begin to resemble those of Alzheimers, though agitation and aggression generally develop before short-term memory loss and other symptoms of later-stage Alzheimers, such as trouble judging distance and difficulty seeing objects in three dimensions.
On average people with frontotemporal disorders live for six to eight years after the onset of symptoms.
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What Stage Of Dementia Is Paranoia And Delusions
Someone who has Alzheimers may believe that his or her family member is stealing or that the police are following them. Paranoia is another name for this type of suspicious delusion. Despite the fact that this is not a reality, dementia is something that people with dementia face in their daily lives.
People with dementia frequently exhibit delusional symptoms . Paranoia is the most common form of this, and it causes the person to feel threatened. A delusion may cause people to believe that they are being watched or that someone is attempting to harm them. People with dementia may become suspicious of others around them. A person who is suffering from dementia may make accusations against others. They may also accuse their partner of infidelity, as well as being an impostor. The distressing process of being falsely accused is clearly a distressing one. Deficiency can be prevented or reduced with a variety of interventions.
It is critical to challenge such delusional beliefs, even if they are difficult to prove. We can alleviate the persons fear and anxiety by empathizing with their concerns, allowing them to live as comfortably and safely as possible.
Challenges With Structured Cognitive Tests Used To Diagnose Dementia With Lewy Bodies And To Measure Change Over Time
Visuospatial functioning has been identified as potential predictor of faster cognitive and functional decline in DLB . However, a more recent study of 67 patients with DLB followed for up to 4 years found no significant association between low visuospatial scores at baseline and faster cognitive decline or progression of dementia severity. The same study assessed cognitive decline on a number of domain-specific tests in patients with DLB comparatively to 119 patients with AD . A difference in the rate of cognitive decline between DLB and AD was only detected in the Trail Making Test A , which assesses visual scanning, psychomotor speed, and attention by asking the participant to draw a line to connect consecutive numbers from 1 to 25 . Older studies also identified that patients with DLB declined slower in recognition memory and recall, but more rapidly in verbal fluency than those with AD .
Overall, assessment of cognition in DLB should not rely on tests predominantly assessing language and memory, and the MoCA appears to be a useful tool to detect cognitive difficulties and progression to dementia. Larger scale evaluations are required in patients who have already been diagnosed with DLB, both to determine MoCAs performance and domain-specific decline.
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Tests For Dementia With Lewy Bodies
There’s no single test for dementia with Lewy bodies.
The following may be needed to make a diagnosis:
- an assessment of symptoms for example, whether there are typical symptoms of dementia with Lewy bodies
- an assessment of mental abilities this will usually involve a number of tasks and questions
- blood tests to rule out conditions with similar symptoms
- brain scans, such as an MRI scan, CT scan or a SPECT scan these can detect signs of dementia or other problems with the brain
Common Forms Of Dementia
Alzheimers disease symptoms include a progressive loss of recent memory, problems with language, calculation, abstract thinking, and judgment, depression or anxiety, personality and behavioral changes, and disorientation to time and place. LBD is frequently misdiagnosed as Alzheimers disease, especially in the early stage. Over time, changes in movement, hallucinations, or RBD can help distinguish LBD from Alzheimers disease.
Lewy body dementia is an umbrella term for a form of dementia that has three common presentations.
Regardless of the initial symptom, over time all three presentations of LBD will develop very similar cognitive, physical, sleep, and behavioral features, all caused by the presence of Lewy bodies throughout the brain.
Vascular dementia is caused by a series of small strokes that deprive the brain of vital oxygen. Symptoms such as disorientation in familiar locations, walking with rapid, shuffling steps, incontinence, laughing or crying inappropriately, difficulty following instructions, and problems handling money . High blood pressure, cigarette smoking, and high cholesterol are some of the risk factors for stroke that may be controlled to prevent vascular dementia.
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What Is Lewy Body Dementia
Lewy body dementia is a degenerative brain disease that causes a progressive decline in cognitive function. The second most common kind of neurodegenerative dementia after Alzheimers disease, LBD ultimately leads to the irreversible loss of intellectual and functional capacity.
Lewy body dementia is characterized by abnormal accumulations of specific proteins in the brain known as alpha-synuclein proteins. These proteins build up within the neurons in areas of the brain related to memory and motor control. These accumulations may have an impact on behavior, movement, cognition, mood, sleep, memory and learning. Research shows that this accumulation is also linked to other diseases like Parkinsons disease and multiple system atrophy.
How Does Lewy Body Dementia Affect You Emotionally
Lewy body dementia can be emotionally devastating for both patients and caregivers. The disease can cause changes in mood and behavior, which can be extremely challenging to deal with. Patients may become depressed, anxious, or agitated, and may have difficulty controlling their emotions. Caregivers may also find themselves struggling to cope with the emotional rollercoaster of the disease.
In mid-March, the UCSF Memory and Aging Center hosted a webinar on Lewy Body Dementia . Wed like to share our thoughts on the webinar with you, as we did at Stanford Parkinsons Community Outreach. This webinar can be viewed via YouTube, and it has been recorded. Because of Lewy body disease, the parts of the brain involved in emotion, motivation, and sleep no longer function normally. While it is not the intent of the person to harm others, the effects of brain disease are felt. Dreaming is frequently used as a means of resolving sleep issues, such as REM behavior disorder . When someone is lacking motivation, interest, or initiative, he or she is suffering from apathy.
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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:
Inclusion And Exclusion Criteria
To select patients with mild dementia only, a MMSE score of at least 20 or a CDR global score=1 was required for inclusion. Patients without dementia or with acute delirium or confusion, terminal illness, recently diagnosed with a major somatic illness which according to the clinician would significantly impact on cognition, function or study participation, previous bipolar disorder or psychotic disorder were excluded. Patients were recruited for brain donation and subsequent pathological diagnosis. Only patients with probable or definite DLB and AD were included in this study.
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Treatment And Care For Lewy Body Dementia
While LBD currently cannot be prevented or cured, some symptoms may respond to treatment for a period of time. An LBD treatment plan may involve medications, physical and other types of therapy, and counseling. A plan to make any home safety updates and identify any equipment can make everyday tasks easier.
A skilled care team often can suggest ways to improve quality of life for both people with LBD and their caregivers.
The Key Difference Between Dementia With Lewy Bodies And Other Forms Of Dementia
Even when dementia with Lewy bodies is not always obvious, the presence of Lewy bodies can be an early sign of dementia. Protein deposits known as leviathan bodies are found in nerve cells in the brain that control movement, thinking, memory, and the flow of information. The loss of thinking, reasoning, and independent function in this case is irreversible.
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Challenges Due To A Delayed Diagnosis Of Dementia With Lewy Bodies
Early correct diagnosis of DLB remains an important challenge and an important step forward is the recent definition of research criteria for mild cognitive impairment in DLB . As in other already established diagnostic standards for MCI in neurodegenerative conditions, the triad of a subjective cognitive concern, an objective impairment in at least one cognitive domain, and largely preserved independent functioning needs to be met . The cognitive impairment can be in any domain, but in the context of DLB, it is more likely to be associated with visuospatial, attentional, or executive deficits. For a diagnosis of MCI-LB, the authors propose that additional core features of DLB , at least one Parkinsonian motor sign) and/or proposed biomarkers need to be present . Depending on the number of symptoms and biomarkers elicited, the research criteria support the diagnosis of either probable MCI-LB or possible MCI-LB .
What Are The Symptoms
The most common symptoms of Lewy body dementia include changes in memory, thinking, movement, behavior, and sleep. Symptoms can appear slowly or without warning and will worsen over time.
People with the condition may not have every symptom in the early stage. People who think they or a loved one may have LBD symptoms should try to keep a list of them and share the list with their health care provider.
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Movement Problems And Lewy Body Dementia
Some people with LBD may not experience significant movement problems for several years. Others may have them early on. At first, movement symptoms, such as a change in handwriting, may be very mild and easily overlooked. Movement problems may include:
- Muscle rigidity or stiffness
Patient Tips For Coping With Lewy Body Dementia
Randal G. shared lessons to help others adjust to life with Lewy body dementia. His tips have been edited for space.
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Lewy Body Dementia Signs And Symptoms
Symptoms of Lewy body dementia include a progressive cognitive decline that interferes with daily activities, unpredictable changes in attention and alertness, visual hallucinations, and motor symptoms similar to those of Parkinsons disease such as slow movements, rigidity, difficulty walking, tremors or shaking, balance issues, and a loss of coordination. The disease affects thinking, behavior, movement, and mood. People with LBD may also experience depression, anxiety, and sleep disorders.
Early signs of LBD may start mild and progress to become more severe. Due to the severity and progression of symptoms, LBD ultimately leads to a loss of independence, requiring individuals with the disease to receive increasing levels of personal assistance and caregiving over time.
Treatment Of Behavior And Mood Problems In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Medications are appropriate if the behavior interferes with the person’s care or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of time is recommended.
The first step is to visit a doctor to see if a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers , and constipation can worsen behavioral problems and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-anxiety medicines can actually increase anxiety in people with LBD. Review your medications with your doctor to determine if any changes are needed.
Antidepressants can be used to treat depression and anxiety, which are common in LBD. Many of them are often well tolerated by people with LBD.
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What Is The Root Cause Of Lewy Body Dementia
Alpha-synuclein deposits in the brain are abnormal, which is why there is a link between Lewy body dementia and the condition. These deposits, known as Lewy bodies, affect chemicals in the brain, causing changes in brain chemistry that can lead to problems such as mood disorders, memory loss, and thinking errors.
What Is The Life Expectancy For People With Lewy Body Dementia
The average life expectancy of Lewy body dementia is five to eight years after the initial diagnosis. But some people with LBD live up to 20 years after their diagnosis.
This short average life expectancy could be due to a lack of knowledge regarding LBD among healthcare providers and the population and difficulty in distinguishing it from other similar conditions. This often leads to a delay in diagnosis, which delays the onset of specific therapy.
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