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When Does Lewy Body Dementia Start

Treating Movement Symptoms In Lewy Body Dementia

What is dementia with Lewy bodies?

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.

Who Gets Dementia With Lewy Bodies

Around 5% of people with a diagnosis of dementia are recorded as having DLB, but there is good evidence that the condition is under-diagnosed. Scientists think DLB may account for up to 20% of all dementia.

Dementia with Lewy bodies affects men and women roughly equally. As with most other types of dementia, DLB becomes increasingly common over the age of 65. It can also affect people younger than this.

There is not much evidence that anything we might be exposed to during our lives increases the risk of DLB. Having a traumatic head injury may increase the risk of developing Parkinsons disease later in life, but its not known whether this also applies to DLB.

Almost all people who develop DLB have a sporadic form, which means that the main cause is unknown. Some genes may increase the risk of developing DLB.

Stage Four: Moderate Cognitive Decline

Many people living with dementia are officially diagnosed during stage four, which is when physicians are able to pinpoint cognitive decline with an exam. At this point, the patient will likely present symptoms such as life-disrupting forgetfulness and out-of-character difficulty performing daily responsibilities. It may become more challenging for those with stage four dementia to manage finances or navigate to new locations.

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How Is Lbd Different From Parkinsons Or Alzheimers

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.

Treatment For Early Lbd Symptoms

Dementia

Over time, the symptoms of Lewy body dementia become more pronounced or frequent. It is a progressive disease and there is no cure for either dementia with Lewy bodies or Parkinsons disease dementia. However, some of the symptoms may be treatable with medications and complementary therapies, such as pet therapy, music therapy, or art therapy.

Managing the symptoms can help reduce and other feelings that may accompany dementia. It can take some trial and error to find effective medications or therapies, but these treatments may help people with Lewy body dementia maintain their quality of life for longer.

If you are a caregiver for someone with Lewy body dementia, speak with your loved ones healthcare team and support groups for ideas on how to best manage dementia symptoms and cope with the challenges of caregiving.

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Stage Five: Moderately Severe Cognitive Decline

Stage five is marked by moderately severe cognitive decline. Individuals in this stage often have notable memory loss and begin to struggle with daily activities. Significant details such as address or phone number may be difficult to recall, and those with stage five dementia will likely need assistance with tasks such as meal preparation and bathing.

Treatment Of Autonomic Dysfunction

Constipation

  • This is an uncomfortable, under-recognized and poorly treated feature of synucleinopathy: 8089 % of PD patients report constipation and/or diarrhea, and 16 % have been hospitalized for bowel obstruction . Although most cases of constipation are secondary to decreased colonic transit and gastrointestinal dysmotility, anorectal dysfunction may contribute significantly in a small set of subjects. Gastrointestinal specialist involvement is important in cases of refractory symptoms.

  • A high-fiber diet combined with adequate hydration, regular exercise and stool softeners is often effective and should be the first step in treatment.

  • When pharmacological interventions are needed, osmotic agents are preferred over prokinetic agents: they have fewer side effects with long-term use.

  • Psyllium and polyethylene glycol are effective .

  • Alternatives include methylcellulose, docusate, magnesium hydroxide, and misoprostol .

  • A recent double-blind, 4-week study found significant improvement with the use of the chloride channel activating agent lubiprostone .

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Dementia & Alzheimer’s Disease

It is important for individuals to know Lewy body dementia stages, especially if you or a loved one is affected by the condition.

This helps you to understand what to expect so that you can tackle it head-on without any unwelcome surprises.

Before we go deep into the stages, lets get an overview of what Lewy body dementia is and its progression.

Signs And Symptoms Of Lewy Body Dementia

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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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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.

Multifaceted Treatment Is Needed In This Complex Disease

DLB is a complex disease with a wide variety of sequelae that each need consideration for treatment . Many symptoms go unreported because they are non-specific, and patients incorrectly assume that physical and psychological symptoms are unrelated to DLB. Treating symptoms with the assumption that they are caused by synucleinopathy is often effective and efficient. For example, a trial of levodopa at bedtime may resolve nocturnal cramps without the discomfort and expense of spinal MRI and electromyography. Given the limitations of current practice models, it is helpful to schedule frequent follow-up visits in the first 3-6 months, with each visit addressing a specific component of the multisystem involvement.

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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.

Treatment And Care For Lewy Body Dementia

Dementia with Lewy Bodies

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.

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What Are The Symptoms Of Lewy Body Dementia

LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:

  • Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
  • Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
  • Visual hallucinations, which means seeing things that are not there
  • Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
  • REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one’s sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
  • Changes in behavior and mood, such as depression, anxiety, and apathy

In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.

Hallucinations Or Delusions Of Reality

Unlike Alzheimers disease, individuals in the early stages of Lewy Body Dementia may exhibit cognitive changes such as hallucinations or distortions of reality. In general, hallucinations caused by LBD are vivid and usually visual, rather than auditory. LBD differs from other forms of dementia in that most early-stage cases do not involve memory loss.

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Stage Two: Very Mild Cognitive Decline

Stage two may bring subtle changes in the individual, such as mild forgetfulness. These instances may include forgetting names or having trouble locating familiar objects. In the second stage of dementia, its difficult or impossible to notice these minor symptoms, and a diagnosis is not yet able to be reached.

What Are Lewy Bodies

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The microscopic findings in brain tissue from LBD patients are different from those in people with AD. The important distinction is that in LBD there are small Lewy bodies inside the brains cells. These Lewy bodies are neither plaques nor tangles, but rather synuclein, the same protein found in brains of people with Parkinsons disease. The clinical disease of LBD reflects the widespread distribution of Lewy bodies, which are especially dense in parts of the brain most specialized for movements, memories, reasoning, and emotions.

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Lewy Body Dementia Stages

With a little bit of information about Lewy body dementia, its now time to jump into the stages of the disease. Like many other dementia types out there, the phases are not cast in stone.

This dementia type also tends to develop at a very slow pace.

Different people may have different experiences.

Below we will tackle three stages that a person with Lewy body dementia may go through.

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Behavioral And Mood Symptoms Of Lewy Body Dementia

Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:

  • Depression
  • Apathy, or a lack of interest in normal daily activities or events and less social interaction
  • Anxiety and related behaviors, such as asking the same questions over and over or being angry or fearful when a loved one is not present
  • Agitation, or restlessness, and related behaviors, such as pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
  • Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living.
  • Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things

What Are The 7 Stages Of Lewy Body Dementia

Nomenclature of Lewy body diseases. Parkinsonâs disease ...

The Seven Stages of Lewy Body Dementia STAGE ONE: NO COGNITIVE DECLINE STAGE TWO: VERY MILD COGNITIVE DECLINE STAGE THREE: MILD COGNITIVE DECLINE STAGE FOUR: MODERATE COGNITIVE DECLINE STAGE FIVE: MODERATELY SEVERE COGNITIVE DECLINE STAGE SIX: SEVERE COGNITIVE DECLINE STAGE SEVEN: VERY SEVERE COGNITIVE DECLINE

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Lewy Body Dementia Symptoms

Symptoms of LBD can fluctuate but usually become progressively worse over time. Early in the disease, fluctuations between normal and abnormal behavior, mood, and cognitive ability can occur. The central feature of this disease is progressive dementia shown by deficits in attention and minor dysfunctions in the early stages that can progress to severe dementia.

In severe dementia, the person’s inability to carry out normal daily functions, loss of recognition of family members, and other severe cognitive, behavior and mood problems can render the individual virtually helpless. Other features include fluctuating cognition, visual hallucinations, and spontaneous features of Parkinsonism such as body stiffness, tremors, shuffling gait, emotionless facial features and/or decreased coordination.

As mentioned previously, the diagnosis is made on the basis of symptoms and their time of occurrence in patients. However, most doctors that make the diagnosis also typically use other tests primarily to rule out other causes for the symptoms.

There are no sensitive or specific blood or urine tests that diagnose LBD. However, routine laboratory tests such as a basic metabolic panel, CBC, thyroid studies, vitamin B12 levels and tests for syphilis, Lyme disease, or HIV also may be ordered. MRI, CT scans, and other studies of the brain are used to help distinguish LBD from other problems that have similar symptoms.

The Link To Parkinsons Disease

Most people with Parkinsons disease have Lewy bodies in their brains. Its these clusters that cause some or all of the motor symptoms of Parkinsons disease, as well as memory or cognitive problems, visual hallucinations, and problems with alertness.

We rarely know if a living patient has Lewy bodies with certainty, however. Its not until an autopsy that they can be seen, says Liana Rosenthal, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine. If we see Lewy bodies in someones brain during an autopsy, thats considered a pathologic certainty of Parkinsons disease, she says.

As with Parkinsons, Lewy body dementia is associated with a depletion of certain neurotransmitters in the brain. These are:

  • Dopamine: This neurotransmitter helps transmit signals that control muscle movement. When the accumulation of Lewy bodies blocks dopamines production and transmission, the result is the hallmark movement issues of Parkinsons disease.
  • Acetylcholine: This neurotransmitter does its work in the parts of the brain responsible for memory, thinking and processing. When Lewy bodies build up in these areas, they interfere with acetylcholine, causing symptoms of dementia.

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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

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