Dementia With Lewy Bodies
Dementia with Lewy bodies, also known as Lewy body dementia, is caused by protein deposits in nerve cells. This interrupts chemical messages in the brain and causes memory loss and disorientation.
People with this type of dementia also experience visual hallucinations and have trouble falling asleep at night or fall asleep unexpectedly during the day. They also might faint or become lost or disoriented.
Dementia with Lewy bodies shares many symptoms with Parkinson and Alzheimer diseases. For example, many people develop trembling in their hands, have trouble walking, and feel weak.
Dealing With Delusions In The Elderly
Delusions among dementia patients typically result from their cognitive impairment. They occur when a senior tries to make sense of a situation, but their confusion and memory problems make it impossible.
They end up filling a hole in a faulty memory with a delusion that makes sense to them, Gwyther says. For example, if a loved one cannot find their purse, they may conclude it is missing because someone stole it. This phenomenon is called confabulation.
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Delusions can be frightening for the person living with dementia, but they can also be very hurtful for caregivers when they are the targets. Recognize that the elderly individual is living in a world that doesnt make sense to them and is likely scared. Do not take any accusations personally or respond with logical explanations. Instead, reassure the person and avoid asking questions that may only cause more confusion. If they are looking for an item, tell them you will help them find it. In cases where a loved one regularly misplaces an item and becomes agitated over the loss, the Alzheimers Association recommends purchasing a duplicate of the item to quickly resolve the issue until the original is found.
Coping With Hallucinations In Elderly Dementia Patients
When it comes to handling a seniors hallucinations, Marion Somers, Ph.D., author of Elder Care Made Easier: Doctor Marions 10 Steps to Help You Care for an Aging Loved One, suggests joining them in their version of reality. Ask the dementia patient about what they are experiencing as if it is real so you can more effectively defuse the situation. Refrain from trying to explain that what they are seeing or hearing is all in their head. Otherwise, youre going to aggravate them, and you dont want to increase the level of agitation, Somers advises.
Reassure them by validating their feelings. Say something like, I see that youre upset. I would be upset if I saw those things, too. Tell them that they are safe with you and you will do everything in your power to help them feel secure.
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A comforting touch, such as gently patting their back, may help the person turn their attention to you and reduce the hallucination, according to the Alzheimers Association. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.
Hallucinations arent just a symptom of Alzheimers disease, either they are also very common in seniors with Lewy body dementia. Furthermore, poor eyesight, hearing loss, certain medications, dehydration and urinary tract infections can all contribute to hallucinations.
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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. .
Treatments For Dementia With Lewy Bodies
There’s currently no cure for dementia with Lewy bodies or any treatment that will slow it down.
But there are treatments that can help control some of the symptoms, possibly for several years.
Treatments include:
- medicines to reduce hallucinations, confusion, drowsiness, movement problems and disturbed sleep
- therapies such as physiotherapy, occupational therapy and speech and language therapy for problems with movement, everyday tasks, and communication
- psychological therapies, such as cognitive stimulation
- dementia activities, such as memory cafes
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Which Dementias Cause Hallucinations
Hallucinations are most common for people with Lewy body dementia, an illness caused by the buildup of proteins called Lewy bodies that disrupt communication between brain cells throughout the brain or kill the cells altogether. Visual hallucinations will often occur in the early stages of the disease, though they eventually stop somewhere in the middle stages and wont recur. People with Lewy body dementia often fluctuate between good days, when theyre thinking normally or at least fairly well, and bad days. In the early stages, those bad days are likely to include visual hallucinations.
Hallucinations will also occur for people with Parkinsons disease with dementia, and for people with Alzheimers. Both those diseases are also associated with a buildup of proteins in the brain. With these dementias, though, hallucinations are more likely to be associated with hearing or feeling. Someone might have conversations with an imaginary person, for example, or think theyre being touched by something that isnt there.
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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Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Disorientation
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Can Dementia Get Worse Suddenly
Dementia is a progressive condition, meaning that it gets worse over time. The speed of deterioration differs between individuals. Age, general health and the underlying disease causing brain damage will all affect the pattern of progression. However, for some people the decline can be sudden and rapid.
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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.
Socialization Could Minimize Some Hallucinations
With dementia-related hallucinations that are mostly auditory, such as hearing people who arent there, having someone real to regularly talk to could help. For times when youre not able to be there in person with your loved one, ask other family members and friends to make an effort to reach out to him or her. In-home care is another way to increase interaction and companionship.
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Parkinsons Alzheimers And Lewy Body Dementia
Since Lewy body dementia is commonly misdiagnosed for both Parkinsons and Alzheimers, it is helpful to understand how these diseases overlap.
| Overlapping symptoms of Parkinsons, Alzheimers, and Lewy body dementia | |
| Parkinsons and Lewy body dementia | Alzheimers and Lewy body dementia |
Some of the motor symptoms found in bothParkinsons and Lewy body patients include:
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Some of the cognitive symptoms found in bothAlzheimers and Lewy bodys patients include:
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What Is Lewy Body Dementia Causes Symptoms And Treatments
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Lewy body dementia is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood. Lewy body dementia is one of the most common causes of dementia.
LBD affects more than 1 million individuals in the United States. People typically show symptoms at age 50 or older, although sometimes younger people have LBD. LBD appears to affect slightly more men than women.
Diagnosing LBD can be challenging. Early LBD symptoms are often confused with similar symptoms found in other brain diseases or in psychiatric disorders. Lewy body dementia can occur alone or along with other brain disorders.
It is a progressive disease, meaning symptoms start slowly and worsen over time. The disease lasts an average of five to eight years from the time of diagnosis to death, but can range from two to 20 years for some people. How quickly symptoms develop and change varies greatly from person to person, depending on overall health, age, and severity of symptoms.
In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease advances, people with LBD require more help due to a decline in thinking and movement abilities. In the later stages of the disease, they often depend entirely on others for assistance and care.
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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 To Help Someone Manage Lewy Body Dementia
When it comes to helping someone manage the symptoms of LBD, small things can often make a big difference.
Create a routine. It can help someone with LBD to have predictable routines, especially around meal times and sleep times.
Establish a nighttime ritual. Try to establish bedtime rituals that are calming and away from the noise of television, meal cleanup, and active family members. Limiting caffeine consumption and daytime napping, and encouraging exercise can help curb restlessness at night.
Modify tasks. Break tasks into easier steps and focus on success, not failure.
Walk together. Taking a walk with the patient with LBD is a win-win activity. Being outdoors and exercising is vital for the health and state of mind for both the patient and you.
Strengthen senses. Have a doctor evaluate each the patients five senses in order to identify and treat any abnormalities. Then ask about exercises to improve them.
Make lifestyle changes. To help minimize the risk of fall-related injuries, you can help stabilize blood pressure. Help your loved one stay well hydrated, exercise, take in adequate sodium , avoid prolonged bed rest, and stand up slowly.
Tips for managing behavioral changes
One of the major challenges of caring for a loved one with dementia can be coping with the troubling behavioral changes that often occur. As a caregiver, you cant change the person with dementia, but you can employ strategies to modify or better accommodate any problem behaviors.
Support groups
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Keep It From Happening Again
You can do some things to help make hallucinations and delusions less likely:
- If your loved one needs glasses, a hearing aid, or dentures, try to make sure they wear them. Check that their glasses are clean and the right ones for the distance. Make sure their hearing aid works and is turned on. Have their eyes and ears checked regularly.
- Make sure all rooms are well-lit. Turn on lights to get rid of shadows and reflections. Shut off sounds that might confuse them, such as noise from a TV, radio, furnace, or air conditioner.
- Keep their home and routine as close to what theyâre used to as you can. Have them be with people they know as much as possible.
- If the same thing always causes them to have problems, change it or take it away if you can.
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Cognitive Symptoms Of Lewy Body Dementia
LBD causes changes in thinking abilities. These changes may include:
- Visual hallucinations, or seeing things that are not present. Visual hallucinations occur in up to 80 percent of people with LBD, often early on. Nonvisual hallucinations, such as hearing or smelling things that are not present, are less common than visual ones but may also occur.
- Unpredictable changes in concentration, attention, alertness, and wakefulness from day to day and sometimes throughout the day. Ideas may be disorganized, unclear, or illogical. These kinds of changes are common in LBD and may help distinguish it from Alzheimer’s disease.
- Severe loss of thinking abilities that interfere with daily activities. Unlike in Alzheimer’s dementia, memory problems may not be evident at first but often arise as LBD progresses. Other changes related to thinking may include poor judgment, confusion about time and place, and difficulty with language and numbers.
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Support For Families And Carers
Dealing with these behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group.
Keep in mind that feelings of distress, frustration, guilt, exhaustion and exasperation are quite normal.
How Can You Tell If Someone Is Hallucinating
Sometimes the person may appear to be hallucinating, but there is another cause . The following tips can help to identify hallucinations:
- Hallucinations differ from misperceptions or misidentifications. Listen to what the person is describing, and check if anything could be causing what they are experiencing. For example, if they describe a swarm of insects, and there is a busy pattern on a carpet, it may be a misperception. By changing or covering the carpet, the misperception may stop.
- If the person seems to be having auditory hallucinations , arrange to have their hearing checked. If the person wears a hearing aid, check that it is working properly at the right setting, and encourage them to wear it. The person may be having problems with their hearing, rather than hallucinating.
- If the person seems to be having gustatory hallucinations , make sure they are getting regular dental check-ups to rule out other causes such as tooth decay or denture cream. For more information see Dental care and oral health.
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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.
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