What Are The Seven Stages Of Lewy Body Dementia
Lewy body dementia or dementia with Lewy bodies is associated with protein deposits in the brain that cause disruptions in the normal functioning of the brain. Diagnosing the disease is extremely tough because its symptoms may resemble other brain diseases. DLB often starts with difficulty moving your body. Within a year, patients may start to have thinking and memory problems that are similar to those in Alzheimers disease along with changes in behavior and hallucinations. The seven stages of LBD are as follows
- Stage one: Absolutely normal stage
- No symptoms. Patients are absolutely normal
- Magnetic resonance imaging or computed tomography scans of the brain might show incidental findings during routine examinations
- Daytime sleeping with hallucinations and mood fluctuations are noticed in some patients
Treatments For Parkinsons Disease Dementia And Dementia With Lewy Bodies
Treatments for DLB are similar to PDD and are aimed at symptom control. The motor symptoms of slowness, stiffness and walking difficulties can be treated with Levodopa. However, Levodopa can cause or exacerbate hallucinations, making it difficult to use it as a treatment for patients who have or are at risk of having hallucinations. Sometimes, clinicians will need to treat the hallucinations more aggressively in order for a patient to tolerate Levodopa given to help the motor symptoms. On the flipside, anti-psychotic medications to control hallucinations can worsen motor symptoms, so treating all the symptoms of LBD simultaneously can be a tricky balancing act.
Getting A Neurologist Referral For Lewy Body Dementia Treatment
Accurate diagnosis is key, as is early treatment action.
Seek a referral to a neurologist experienced in treating Lewy Body Dementia. There are medications known to alleviate certain LBD symptoms. There are also common antipsychotic medications that do more harm and exacerbate symptoms.
Work with an expert whos up-to-date with the most current LBD research for optimized treatment.
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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.
Lewy Body Dementia: A Common Yet Underdiagnosed Dementia
While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.
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Prognosis And Nursing Home Placement
Patients and families expect clear and concise information about dementia prognosis and are often disappointed with the divergent responses from clinicians. Prognosis is difficult from the clinician perspective because of the significant variability among patients and the multitude of contributing factors to health outcomes. Additionally, there is conflicting information about LBD progression, with an average duration of 5 to 7;years and range of 2 to 20;years . Patients and caregivers are sometimes relieved to be given a diagnosis other than AD, due to lack of knowledge about other degenerative dementias and a sometimes false perception that anything else is preferable. Because LBD is often misdiagnosed or underdiagnosed, there may be a different sense of relief with diagnosis to finally receive an answer that explains the constellation of symptoms.
Other comparison studies evaluating survival differences in patients with AD and DLB have found that when comparing the groups based on Mini-Mental State Examination score, the survival time is shorter in DLB . The evidence suggests that DLB patients may have worse mortality outcomes; however, the rate of cognitive decline over time is similar between DLB and AD patients . There is no difference in mortality rates or time to nursing home placement between patients with pure forms of DLB compared to mixed pathology with both DLB and AD .
How Do Doctors Diagnose Lewy Body Dementia
Unfortunately, LBD is usually the most frequently misdiagnosed type of dementia. LBDA estimates that it often takes about three doctors and over a year and a half to diagnose LBD. Their survey of nearly 1,000 participants with LBD discovered that about 80 percent of them were misdiagnosed. In an article published in nature, Susan Schneider Williams, Robin Williams wife, writes about their struggle to get an accurate diagnosis and determine what was happening to his brain. My hope is that it will help you understand your patients along with their spouses and caregivers a little more. And as for the research you do, perhaps this will add a few more faces behind the why you do what you do, she writes.
People can either be diagnosed with dementia with Lewy bodies or Parkinsons disease dementia. If someone is experiencing symptoms that could be LBD, they should try visiting a neurologist, rather than a general physician, to try and get an accurate diagnosis. While LBD can still only be officially diagnosed by an autopsy, doctors use the following methods to determine if someone may have LBD:
They can look for biomarkers of Lewy Body Dementia, including abnormal proteins, with the following:
- A SPECT or PET scan
- ;cardiac scintigraphy, which looks at how nerves are functioning in the hearts blood vessels
- Sleep tests that monitor brain waves
In addition, doctors may do the following:
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How Does Lewy Body Dementia Affect Sleep
People with LBD often experience REM sleep behavior disorder . Scientists believe studying this connection may help them better predict who will develop LBD. Those with RBD act out vivid or violent dreams. People may scream, kick or punch while they sleep. Those with LBD may also experience these sleep-related symptoms:
- Trouble falling asleep
- Restless legs syndrome;
Clinical History And Testing
Diagnostic tests can be used to establish some features of the condition and distinguish them from symptoms of other conditions. Diagnosis may include taking the person’s medical history, a physical exam, assessment of neurological function, testing to rule out conditions that may cause similar symptoms, brain imaging, neuropsychological testing to assess cognitive function,sleep studies, or myocardial scintigraphy. Laboratory testing can rule out other conditions that can cause similar symptoms, such as abnormal thyroid function, syphilis, HIV, or vitamin deficiencies that may cause symptoms similar to dementia.
Dementia screening tests are the Mini-Mental State Examination and the Montreal Cognitive Assessment. For tests of attention, digit span, serial sevens, and spatial span can be used for simple screening, and the Revised Digit Symbol Subtest of the Wechsler Adult Intelligence Scale may show defects in attention that are characteristic of DLB. The Frontal Assessment Battery, Stroop test and Wisconsin Card Sorting Test are used for evaluation of executive function, and there are many other screening instruments available.
If DLB is suspected when parkinsonism and dementia are the only presenting features, PET or SPECT imaging may show reduced dopamine transporter activity. A DLB diagnosis may be warranted if other conditions with reduced dopamine transporter uptake can be ruled out.
Patient Quality Of Life
QOL indicators in patients with dementia have been shown to be associated with inner strength and patients more likely to complete instrumental activities of daily living exhibit higher levels of QOL . The evidence on QOL in patients with LBD is lacking, but one study that did seek to investigate QOL found that DLB patients were less able to self-report QOL compared to AD patients with similar cognitive performance . Caregivers assessments of patient QOL were lower than patient self-reporting. However, regardless of whether the patient or caregiver determined QOL, the DLB patients scored lower on QOL measures compared to AD patients. One possible explanation for this was the higher apathy seen in DLB. Caregivers rated DLB patients to be in a health state equal to or worse than death in 24% of cases, compared to 6% in the AD group. QOL determinants in DLB patients included the Neuropsychiatric Inventory score, apathy, delusions, dependency with IADL, and whether the patient was living with a caregiver .
Recurrent well-formed visual hallucinations are one of the core features of LBD, and may occur in up to 80% of patients . One study found that the most common visual hallucinations included fully formed adults or children , animals or insects , and objects . Hallucinations were more likely to occur early in the disease course, within the first 5;years of diagnosis. Some patients have reported pleasurable hallucinations .
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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Progression Of Lewy Body Dementia
One of the things that you must note is that Lewy body dementia does not have a straight progression path. It, however, has some characteristics that are likely to show up during the early stages.
Other symptoms also come about when a person already has the illness in the later stages.
What stands out with LBD is that the symptoms often fluctuate.
Many at times a person may function well one day and the next, they experience intense and abrupt memory loss. This can be quite puzzling to people around them, as this may also happen in a single day.
Understanding the fluctuation aspect of the disease is helpful to the person with the condition and those around them as well.
This way, a person will not feel like the affected individual is pretending to forget or like they have moved from one stage of the disease to the next.
While in all honesty, variation in functioning is typically a constant with almost all of the stages of Lewy body dementia.
On average, after diagnosis, people with Lewy body dementia will live for six to twelve years though some live longer, for twenty or more years.
What Are The Types Of Lewy Body Dementia
There are two types of LBD: dementia with Lewy bodies and Parkinson’s disease dementia.
Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive and movement symptoms start.
Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer’s disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.
Parkinson’s disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson’s disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.
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
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:
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Apda In Your Community
Here are two common scenarios that may sound familiar:
Scenario 1A patient develops a series of neurologic symptoms, is evaluated by a neurologist and is told that she has Parkinsons disease . She then visits another neurologist for a second opinion and is told she has Lewy Body Dementia .
Scenario 2A patient has his first visit with his neurologist and is told that he has PD, at a subsequent visit the diagnosis is changed to Parkinsons disease dementia , and at a follow up visit the diagnosis is changed yet again to Dementia with Lewy Bodies .
Both of these situations understandably cause great uncertainty and frustration.
Are There Medicines To Treat Dlb
Though there is no cure for DLB yet, there are medications that help manage the symptoms. These medications are called cholinesterase inhibitors, and they can help if a person with DLB is having memory problems. Some examples of these medicines are donepezil, rivastigmine and galantamine. If a person with DLB has movement symptoms they may be treated with medications used for Parkinsons disease, such as levodopa. Sleep problems may be managed by sleep medications including melatonin.
Because people with DLB are usually very sensitive to medications, any new medication, even one that is not being used for the brain, needs to be reviewed with the persons provider to avoid potential contraindication.
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Planning For The Future With Lewy Body Dementia
Caring for someone with Lewy Body Dementia requires a balanced approach.
On one hand, its essential to plan for the future; on the other, its important to be present in the moment and take things day-by-day. Depending on your loved ones symptoms and disposition, its critical to be flexible in terms of routine because things can change suddenly.
For example, those caring for someone with LBD find things go best when life moves at a slower pace, with fewer expectations and more flexible schedules. Things like art, music, gardening and sharing favorite foods may take precedence over other, more distracting activities.
What Other Things Help
There are various ways to help a person with DLB. Speech therapy may help improve communication between people with DLB and others. Physical therapy may help strengthen and stretch stiff muscles and help to prevent falls.
Research has shown that;physical exercise helps to enhance brain health and improves mood and general fitness. A balanced diet, enough;sleep, and limited alcohol intake are other important ways to promote good brain health. Other illnesses that affect the brain, such as diabetes, high blood pressure, and high cholesterol, should also be treated if present.
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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.
Two Of The Following Are Present :
- Fluctuating cognition: Mental problems varying during the day, especially attention and alertness.;
- Visual hallucinations: Detailed and well-formed visions, which occur and recur.;
- RBD: Physically acting out dreams while asleep.
A DLB diagnosis is even more likely if the individual also experiences any of the following: repeated falls, fainting, brief loss of consciousness, delusions, apathy, anxiety, problems with temperature and blood pressure regulation, urinary incontinence, and chronic constipation, loss of smell, or sensitivity to neuroleptic medications that are given to control hallucinations and other psychiatric symptoms.
Finally, the timing of symptoms is a reliable clue:;if cognitive symptoms appear before or within a year of motor symptoms, DLB is more likely the cause than Parkinsonâs disease. Signs of stroke or vascular dementia usually negate the likelihood of DLB.
Testing is usually done to rule out other possible causes of dementia, motor, or behavioral symptoms. Brain imaging can detect brain shrinkage and help rule out stroke, fluid on the brain , or subdural hematoma. Blood and other tests might show vitamin B12 deficiency, thyroid problems, syphilis, HIV, or vascular disease. Depression is also a common cause of dementia-like symptoms. Additional tests can include an electroencephalogram or spinal tap .
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