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Physical Therapy For Lewy Body Dementia

Research Paperpromoting Independence In Lewy Body Dementia Through Exercise Study: Protocol For A Pilot Study

Lewy body dementia and its rapid decline

Design of the first empirical trial to investigate exercise benefits in Lewy body dementia.

Anabolic exercise – progressive resistance and balance training is utilised.

Function and frailty components are assessed across wait-list and intervention periods.

Evidence on feasibility and effect sizes will lay groundwork for future robust clinical trials.

Support And Other Therapies

In addition to medicine, there are a number of therapies and practical measures that can help make life easier for someone with dementia.

These include:

  • occupational therapy to identify problem areas in everyday life, such as getting dressed, and help make life easier
  • speech and language therapy to help improve communication or swallowing problems
  • physiotherapy to help with movement
  • psychological therapies, such as cognitive stimulation
  • relaxation techniques, such as massage, and music or dance therapy
  • social interaction, leisure activities and other dementia activities, such as memory cafes
  • home modifications, such as removing trip hazards, ensuring the home is well lit, and adding grab bars and handrails

Dementia With Lewy Bodies And Neuroleptics

Neuroleptics, or antipsychotics, are strong tranquillizers sometimes prescribed for people with dementia to treat hallucinations or other behavior problems. However, if taken by people with LBD, neuroleptics may be particularly dangerous. This class of drugs can induce Parkinson-like side-effects, including rigidity, immobility, and an inability to perform tasks or to communicate.

If you or your loved one with Lewy body dementia is not unduly distressed by the hallucinations, it may be better to tolerate them rather than endure the side effects of the medication. If, however, you and your doctor decide to use a neuroleptic, this should be done with the utmost care and monitored carefully and regularly.

According to Lewy Body Dementia Association:

Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible Parkinsonism, or symptoms resembling neuroleptic malignant syndrome , which can be fatal. .

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Treating Movement Symptoms In Lewy Body Dementia

LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.

People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.

Caring For Someone With Lewy Body Dementia

Pin on Aging parent/ dementia

Caring for someone with LBD, or any form of dementia, is hugely challenging. Just as LBD can impact every aspect of a person, caring for someone with the disease can impact every aspect of your daily life. Youll likely face tests of stamina, problem solving, and resiliency. However, your caregiving journey can also be an intensely rewarding experience as long as you take care of yourself and get the support that you need.

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Lewy Body Dementia: The Role Of The Pt Ot And Slp In Person

Master skills to implement in your practice immediately with continued Master Class. The complexity of Lewy body dementias and evaluation and intervention approaches for PTs, OTs, and SLPs will be examined in this class. Case studies emphasize opportunities and approaches for interprofessional collaboration to provide comprehensive, person-centered care.

Course created on September 29, 2022

Mechanisms For Dementia And Disease

Multiple pathologic processes have been linked to cognitive impairment and psychosis in DLB and PDD, including -synuclein deposition with secondary synapse impairment,7,52,53 amyloid burden,10,54 and dopamine55 and acetycholine9 cell loss .5260 The difference in the timing of cognitive and motor impairments in DLB and PDD likely reflects a difference in the temporal sequence of these pathologies. One possibility is that in DLB, cortical lesions, mostly -amyloid, arise early, driving cognitive impairment. Then, -synuclein pathology ascends from brainstem to cortex. In contrast, in PDD, cortical lesions arise late, and ascending -synuclein pathology drives the clinical syndrome. Amyloid PET imaging in DLB and PDD supports this model, showing high amyloid burden in most cases of DLB, with more modest accumulation in PDD.54 Antibodies targeting -amyloid have entered clinical trials in AD and MCI.61 Although the outcomes are uncertain, the strategy is applicable to DLB and possibly to PDD, where amyloid accumulation appears to contribute to certain clinical features, including the timing and rate of cognitive decline.54 A similar immune targeting approach is under development for -synuclein. If successful, this strategy would be applicable to both DLB and PD, irrespective of cognitive impairment.

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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

How Is Lbd Different From Parkinsons Or Alzheimers

Lewy Body Dementia: My Father

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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Strengths Of This Review

This is the first review of exercise in LBD. It was rigorously executed across 19 reputable databases and was continually updated over a period of eight months through RSS and email search updates. All types of full-length articles in any language were reviewed regardless of publication status. Authors of included and excluded papers were contacted for additional data or information if warranted, which ensured all available information on LBD cohorts could be included in the review.

The review protocol was registered prospectively with PROSPERO and conformed to PRISMA guidelines in all applicable areas .

Judy Towne Jennings Pt Ma

Judy Towne Jennings, PT, MA, is a physical therapist trained in geriatrics and pediatrics. She was an enthusiastic baby-development specialist until caring for her husband forced her to become an expert in caregiving for this strange disease, Lewy Body Dementia. Judy has been a voice for those who could not speak for themselves.

Judy has lectured extensively on the importance of early tummy time for infants. With the experience gained while caring for her husband, she will now become a voice for those with a deteriorating neurological disease. Judy is the author of “Living with Lewy Body Dementia, One Caregivers Personal, In-Depth Experience”. Judy has extensive experience in orthopedic physical therapy. She trained and worked with Peter Towne, PT, FAPTA and Linda Towne PT. MEd for many years.

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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.

Coping With Lewy Body Dementia

Stages or Phases of Lewy Body Dementia

Coping with Lewy body dementia involves much more than your treatment plan. Its also essential to have access to social support and a safe home.

In the early stages of this condition, symptoms are typically milder, and people with LBD can function. However, as the disease progresses, there will be a severe decline in cognitive and motor abilities, and assisted care will be necessary.

Taking care of your physical healthy by exercising regularly and eating nutritious meals, is also important. Symptoms of anxiety and depression could develop as a result of this condition. Speaking to a therapist who has experience working with people who have dementia, will help.

Behavioral changes are to be expected with LBD. Keeping a diary to track your triggers and what times of the day you experience changes in your behavior, will help you understand your condition better.

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What Is Lewy Body Dementia

Lewy body dementia is a type of dementia in which Lewy bodies are present in your brain. Lewy bodies are clumps of proteins that build up inside certain neurons . They cause damage to neurons in the areas of your brain that affect mental capabilities, behavior, movement and sleep.

Lewy body dementia is a progressive disease, meaning symptoms start slowly and get worse over time.

In people over the age of 65, LBD is one of the most common causes of dementia. The symptoms of LBD may closely resemble those of other neurological conditions, including Alzheimers disease and Parkinsons disease.

Theres no cure for LBD, but the symptoms can be managed with certain medications. You or your loved one may also benefit from nonmedical treatments like physical therapy and speech therapy.

Signs And Symptoms Of Lewy Body Dementia

As with Alzheimers disease or Parkinsons disease, the symptoms of Lewy body dementia worsen over time, with intellectual and motor functions deteriorating, typically over several years. Despite the overlaps, however, there are symptoms that indicate the disorder is indeed LBD and not another condition.

While patients with LBD lose cognitive function, they are less prone to the short-term memory loss associated with Alzheimers disease. More commonly, they experience greater problems with executive functions of planning, decision-making, and organization, as well as difficulties with visual perception, such as judging and navigating distances. This can cause you to fall or faint frequently or become lost in familiar settings. Lewy body dementia can also cause sleep disturbances, including insomnia and daytime sleepiness.

If you have Lewy body dementia, you will also exhibit at least two of four core features:

Changes or fluctuations in awareness and concentration. You swing from a state of alertness to appearing drowsy, confused, or staring into space. These episodes can be unpredictable and last anywhere from a few seconds to several hours.

Spontaneous Parkinsons-like motor symptoms, such as slowness of movement, rigid muscles, tremor, lack of facial expression, or abnormal gait.

Recurrent visual hallucinations or delusions, such as seeing shapes, colors, people, or animals that arent there or conversing with deceased loved ones.

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Symptoms Of Lewy Body Dementia

Symptoms of Lewy body dementia include:

  • Hallucinations visual hallucinations are often a first sign of Lewy body dementia patients may see objects, people or animals that are not there.
  • Impaired thinking cognitive function may be impaired, so patients with Lewy body dementia may have challenges thinking clearly, memory loss, poor attention span and feel confused.
  • Difficulty walking patients with Lewy body dementia may shuffle, become rigid or walk more slowly.
  • Difficulty sleeping patients with Lewy body dementia report acting out dreams while they are sleeping.
  • Changes in behavior changes in behavior, such as loss of attention span, loss of motivation or speech problems, can occur in patients with Lewy body dementia.
  • Tremors Parkinsons disease-like tremors can occur in patients with Lewy body dementia.

Symptoms start slowly and intensify as the disease progresses. In late stages of the disease, patients with Lewy body dementia may need assistance to perform day-to-day activities.

Diagnosis of Lewy body dementia

It is difficult to diagnose Lewy body dementia because symptoms are similar to other progressive brain disorders such as Alzheimers disease. If you think you or a loved one has Lewy body dementia, schedule an appointment with a Mercy Health neurologist for testing.

Other testing to diagnose Lewy body dementia includes:

Mild Cognitive Impairment And Dementia In Parkinson Disease

Family grateful for Lewy body dementia treatment | Ohio State Medical Center

Contrary to Dr James Parkinsons introduction to An Essay on the Shaking Palsy,18 the intellect is not uninjured in PD. Although patients with PD first come to medical attention because of characteristic motor signs, including rest tremor, rigidity, bradykinesia, and gait abnormality, specific cognitive impairments in executive function, visual-spatial skill, and even memory function in patients with PD are common and have been known for more than 40 years.19 PD hastens deterioration of these cognitive abilities over time, with the incidence and prevalence of cognitive impairments increasing with duration and severity of illness.20,21 In this sense, PD can be considered a risk factor for dementia. Formal criteria have been developed for mild cognitive impairment in PD .22,23 These criteria attempt to account for the contribution of motor impairment to functional decline and are now being validated.

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Baseline Physical Function Characteristics

Baseline physical function is presented in Table 4. Habitual gait speed reported for 15/16 participants ranged from 0.36â0.96 m/s . Maximal gait speed was only reported in 4/16 participants and ranged from 0.49â1.1 m/s. Dual task gait speed was measured in 9/16 participants with a mean walking speed of 0.65 m/s. Walking distance was seldom recorded, with only one case report recording a six-minute walk distance of 430.86 m.

What Causes Lewy Body Dementia

A buildup of Lewy bodies causes both dementia with Lewy bodies and Parkinsons disease dementia. When Lewy bodies build up in neurons, they cause damage to certain areas of your brain.

Researchers dont know why some people develop LBD while others dont. Theres some thought that the combination of mutations in a persons genes, environmental risk factors and natural aging might lead to the development of LBD in some people. Research into specific causes is ongoing.

One of the more recent discoveries toward identifying a cause of Lewy body dementia is the finding of an increasing number of gene mutations. Two genetic risk factors recently discovered are variants in the APOE and GBA genes.

APOE is already known to increase the risk of developing Alzheimers disease. Theres growing evidence that it also increases the risk for dementia with Lewy bodies. Similarly, the GBA gene increases the risk for both Parkinsons disease and dementia with Lewy bodies. Despite these findings, genetic changes as a cause of LBD are still considered rare by scientists. Most cases of Lewy body dementia arent thought to be inherited .

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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. Symptoms fluctuate over time and vary from person to person.

There are several possible symptoms of LBD, which can be grouped into the following categories:

  • Movement issues.
  • Smaller handwriting than whats normal for the person.

Cognitive symptoms of Lewy body dementia

Fluctuating cognitive function is a relatively specific feature of Lewy body dementia. A person with LBD may experience periods of being alert and coherent in between periods of being confused and unresponsive to questions. This can change from day to day or within the same day.

Other cognitive symptoms include a decline in:

  • Planning abilities.
  • Problem-solving skills.
  • Ability to focus.
  • Understanding information in visual form.

Visual hallucinations, or seeing things that arent there occur in up to 80% of people with LBD and often early on in the condition. Other types of hallucinations, such as hearing or smelling things that arent there, are less common than visual ones but may also occur.

Visuospatial difficulties, including decreased depth perception, trouble recognizing familiar objects and impaired hand-eye coordination, are also common in people with LBD.

Sleeping problems in Lewy body dementia

Other sleep issues associated with LBD include:

  • Excessive daytime drowsiness.

Dysautonomia in Lewy body dementia

  • Changes in body temperature.

How Is Lewy Body Dementia Diagnosed

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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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