Is There Treatment Available
At present there is no cure for Lewy body disease. Symptoms such as depression and disturbing hallucinations can usually be reduced by medication. However, medications to relieve hallucinations may increase muscle tremors and stiffness. Conversely, anti-Parkinson drugs may make hallucinations worse.
Emerging evidence suggests that cholinesterase inhibitor drugs may be quite helpful for some people with this condition.
People with this form of dementia are very sensitive to the side effects of neuroleptic drugs such as antipsychotic medications. It is essential all medications are supervised by a specialist to avoid these severe side effects.
How Common Is Lewy Body Dementia
After AD, Lewy body dementia or dementia with Lewy bodies is one of the most frequent causes of dementia, affecting some 1.3 million Americans. To put this in perspective, Alzheimers affects about four times as many older adults. LBD usually can begin between ages 50 and 85, and typically becomes clinically apparent during a persons mid-to-late 70s. The disease usually runs its course over about 6 years.
Rem Sleep Behavior Disorder
LBD patients sometimes experience REM sleep behavior disorder. The condition involves a dysfunction that makes them physically act out situations in their dreams. Studies suggest that REM sleep behavior disorder can be an early symptom of LBD.
On the other hand, while some type of sleep disturbance may occur in people with Alzheimers, REM sleep behavior disorder is not typically associated with it.
What Causes Dementia With Lewy Bodies
It is not yet known why Lewy bodies develop in the brain or exactly how they cause dementia. But we do know that Lewy body disease:
- can cause different symptoms depending on what parts of the brain have the biggest build-up of faulty proteins
- reduces the levels of important chemicals needed to send messages around the brain
- breaks the connections between nerve cells, eventually causing these cells to stop working
- usually develops over a period of many years typically when a person is approaching old age. Lewy bodies can be developing in the brain for a long time before any symptoms show.
Having Lewy body disease doesnt mean that a persons dementia is only caused by the build-up of Lewy bodies in their brain.
Many people with DLB also have a build-up of other proteins that cause Alzheimers disease. This is common in people over about 80 years old. For people with both DLB and Alzheimers, dementia symptoms are often more severe and progress more quickly.
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
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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.
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.
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Causes Of Dementia With Lewy Bodies
Dementia with Lewy bodies is caused by clumps of protein forming inside brain cells. These abnormal deposits are called Lewy bodies.
These deposits are also found in people with Parkinson’s disease, and they build up in areas of the brain responsible for functions such as thinking, visual perception and muscle movement.
It’s not clear why the deposits develop and how exactly they damage the brain. It’s thought that part of the problem is the proteins affecting the brain’s normal functions by interfering with signals sent between brain cells.
Dementia with Lewy bodies usually occurs in people with no family history of the condition, although there have been very rare cases that seem to run in families.
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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Differences Between Lbd And Alzheimers
There are key differences between LBD and Alzheimers. For example, a person with LBD will develop parkinsonian motor symptoms, whereas someone with Alzheimers disease does not have these movement symptoms as part of Alzheimers.
Unlike someone with Alzheimers only, someone with LBD may often have problems with autonomic function, such as:
- Abnormalities in blood pressure
- Urinary incontinence
- Fainting spells
- Sexual dysfunction
People with LBD also have fluctuations in mental function. This means that their cognitive symptoms can change greatly from one day to the next especially regarding attention and alertness. Those who have LBD experience visual hallucinations, and people with Alzheimers disease do not. A person with LBD can have REM sleep behavior disorder, which is not part of Alzheimers.
Parkinson’s Dementia Vs Dementia With Lewy Bodies
Have you ever wondered if there was any difference between dementia with Lewy bodies and Parkinson’s disease dementia? If you’ve ever heard the symptoms of these two disorders, they sound surprisingly alike. That’s because they’re both types of Lewy body dementia: dementia with Lewy bodies and Parkinson’s disease dementia .
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What Is The Link Between Parkinsons And Lewy Body Dementia
Being Patient: Are Parkinsons disease and Lewy body dementia related?
Dag Aarsland: Yes, theyre related in terms of symptoms and the brain changes. Many scientists consider Parkinsons and Lewy body dementia as a continuum of disease rather than two separate diseases. But there are very active and lively discussions about that. There are arguments for separating and combining them, but there are many similarities.
Being Patient: Do you group Lewy body dementia with Parkinsons disease in your research?
Dag Aarsland: From a research point-of-view, we try to separate them. We identify the specifics and categorize patients in different groups and study them carefully in order to see how they relate. In clinical practice, its different. I also see patients with Parkinsons and unfortunately, many of them develop dementia and hallucinations or memory problems. In clinical practice, its very much the same challenges for patients, carers and the doctor in terms of findings and the right therapy.
The Effects Of Alzheimers On The Brain
In people with Alzheimers disease, brain cells die and connections between brain cells may break down. One of the hallmark symptoms is abnormal protein deposits in the brain called plaques and tangles.
Plaques are dense clusters of protein that can block communication between neurons. Tangles are proteins that twist together that lead to the death of healthy brain cells.
In advanced Alzheimers, the brain shows significant shrinkage. Changes in the brain may occur a or more before symptoms start.
Its impossible to diagnose Alzheimers with complete accuracy while a person is alive. The diagnosis can only be confirmed when the brain is examined under a microscope during an autopsy. However, specialists can make the correct diagnosis up to 90 percent of the time.
The symptoms of Alzheimers and dementia can overlap, but there can be some differences.
Both conditions can cause:
- behavioral changes
- difficulty speaking, swallowing, or walking in advanced stages of the disease
Some types of dementia will share some of these symptoms, but they include or exclude other symptoms that can help make a differential diagnosis.
Lewy body dementia , for example, has many of the same later symptoms as Alzheimers. However, people with LBD but are more likely to experience initial symptoms such as visual hallucinations, difficulties with balance, and sleep disturbances.
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Coping With Cognitive Changes
Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.
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.
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Special Concerns For The Caregivers
Caregivers of patients with LBD are stressed in many of the same ways as caregivers of AD patients. The cognitive decline, decreasing functional capacity, and non-cognitive disturbances are every bit as stressful. In addition, though, LBD patients can present special concerns because their ability to function changes from day to day. Their falls and hallucinations add further stress and risk. Their response to cognitive enhancers such as the cholinesterase inhibitors or memantine can be as good as that of AD patients, so their use should be considered.
Walking And Physical Movement
Vascular dementia: Vascular dementia is often accompanied by some physical challenge. If a person has a stroke, they may have limited movement on one side of her body. Both the cognitive and physical impairments related to vascular dementia usually develop at the same time since they are often the result of a sudden condition like a stroke.
Alzheimers: Often, mental abilities like memory or judgment decline initially, and then as Alzheimer’s progresses into the middle stages, physical abilities like balance or walking show some deterioration.
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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.
Is Dementia A Symptom Of Both
One of the biggest similarities between PD and LBD is dementia. Some studies have found that approximately 78 percent of PD patients will eventually develop dementia. More specifically, almost half of Parkinsons patients will develop a certain type of dementia called Parkinsons Dementia, usually 10-15 years after their initial PD diagnosis.3,4
People with Parkinsons Dementia commonly experience poor memory and concentration, slowed thinking, confusion, depression, emotional changes, delusions, and visual hallucinations.
Parkinsons dementia is different than LBD, mainly in which symptoms occur first . Patients with Parkinsons Dementia will first show Parkinsons motor symptoms, followed by dementia many years after diagnosis. Conversely, LBD patients will first show dementia symptoms and may show motor symptoms later.3
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Lewy Body Dementia Progression And Treatment
Being Patient: How common is Lewy body dementia?
Dag Aarsland: From a scientific point of view, we dont actually know how common it is, but based on the studies that exist, I think most scientists would agree that if you look at a whole group of people with dementia, between 1015 percent of all patients with dementia have Lewy body dementia. Thats a big group of people. We usually consider Lewy body dementia to be the second most common form of dementia after Alzheimers disease, together with vascular dementia.
Being Patient: Can people have Lewy body dementia and Alzheimers at the same time?
Being Patient: How quickly does Lewy body dementia progress? Is it different than other forms of dementia?
Being Patient: What are the treatments for Lewy body dementia and are there any prevention strategies?
Dag Aarsland: Unfortunately, since theres much less research, we know less about preventative strategies for Lewy body disease compared to Alzheimers and Parkinsons, but if you look at lifestyle and prevention, I think when strategies seem to be protective for Alzheimers, like physical exercise, a healthy diet, mental activities, etc., they should also be implemented for people with Lewy body disease. Theres no research there but no good argument as to why they should not be effective for this group of patients.
Vascular Dementiaa Real Blood Vessel Stumbling Block
Those with dementia are still people and they still have stories and they still have character and they are all individuals and they are all unique. And they just need to be interacted with on a human level.
While Alzheimers is the first most common type of dementia, Vascular Dementiameaning dealing with the blood vesselsis the second.
When Do Vascular Dementia Symptoms Start?
Alzheimers can actually start years before symptoms show up. But Vascular Dementia? It tends to be sudden, seemingly overnight, like theyre taking giant steps downhill.
Change can happen slowly, but its often dramatic.
- It rarely happens before age 65, and
- Chances escalate significantly as Grandma reaches her 90s.
To complicate diagnosis? Vascular Dementia and Alzheimers often occur together.
What Are the Symptoms?
It all depends on what part of the brain is affected.
While Alzheimers tangles and plaque tend to start building in the hippocampus and gradually moves to the frontal lobe
Vascular Dementia can hit anywhere you have blood vessels in the brain.
Which means anywhere.
And different parts of the brain control different things.
But the most common symptoms are:
The long and short? Reduced circulation to the brain.
- Maybe from a stroke that blocks an artery.
- Maybe from other conditions that damage blood vessels
As the blood struggles to get through, that spot of the brain cant get oxygen and nutrients.
Either way, the risk increases with each stroke.
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