What Is Lewy Body Dementia?
Several degenerative brain diseases affect cognitive function in people of all ages. One such type of dementia is diffuse Lewy body dementia, which can impact millions of people worldwide. Understanding this condition and its symptoms may prepare you if you or someone you love is experiencing symptoms.
What’s the origin of the name?
Over 100 years ago, in 1912, Fritz Heinrich Lewy studied the brains of people with Parkinson's disease. He found that there were bodies of protein in the nerve cells of the brain's basal ganglia. The basal ganglia are structures in the base of the brain that are involved in movement and coordination.
Although Lewy noticed these bodies, he didn't know that it was characteristic of a specific type of disease. Nevertheless, his contribution to the science of dementia was significant enough that Lewy bodies and Lewy body dementia were named after him.
Lewy bodies are abnormal formations of protein. They develop inside nerve cells and contribute to Parkinson's disease with or without dementia and Lewy body dementia. They look like a spherical mass and have a dense core and a radiating halo.
What does “diffuse” mean in LBD?
How Lewy bodies affect the brain
Lewy bodies impact the way the brain works. They can cause multiple problems with brain functioning that go beyond the potential forgetfulness of old age. Below are some of the impacts.
REM sleep behavior disorder
Severe neuroleptic sensitivity
Doctors can treat hallucinations, delusions, or other behavioral disturbances in most dementias with neuroleptic medications such as haloperidol. However, 50% of people with Lewy body dementia are susceptible to these medications. They have severe reactions that can lead to faster cognitive decline, parkinsonism, drowsiness, neuroleptic malignant syndrome (NMS), or death. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptics that can cause fever, rigidity in the muscles, and changes in mental state.
Reduced dopamine transporter activity
Risk factors for LBD
- Changes in reasoning
- Confusion or alertness at different times
- Hunched posture
- Balance difficulties, including frequent falls
- Changes in handwriting
- Weak voice
- Loss of smell
- Misidentifying objects in low light
- REM sleep disorder
- Shuffling gait
Memory and cognitive symptoms
People with LBD may have difficulty interacting in conversations or could start to speak in a disorganized way. They may become confused. Spatial relationships may be complicated to assess, and they may lose their sense of direction.
Psychiatric symptoms
People with diffuse LBD may have visual or auditory hallucinations or hallucinations related to other senses, such as touch. They may have depression, become apathetic, and have delusions or false beliefs. They may also struggle with anxiety. Visual hallucinations can be distinctive symptoms that indicate a patient has Lewy body dementia (LBD) rather than another type of dementia.
Parkinsonian symptoms
Sleep problems
Autonomic system dysfunction
Unpredictability in severity of symptoms
With an early diagnosis, you or your loved one can receive treatment for their symptoms. You can also benefit from community resources and information about caring for a loved one with LBD.
How LBD is diagnosed
- Fluctuating alertness and thinking problems
- Visual hallucinations
- Parkinsonian symptoms
- REM sleep behavior disorder
If you are experiencing symptoms involving thinking and memory issues, it may be helpful to bring a family member to doctor’s appointments so they can help you understand and remember what the doctor is telling you. Someone close to you may also help give a full picture of the symptoms you’re experiencing, such as noting when visual hallucinations occur or discussing a loss of cognitive function that they’ve noticed.
Vital signs
The doctor may check your vital signs and ask you to do so at home for a period as well. They often look for blood pressure, heart rate, and body temperature instability. They may also note autonomic changes like sweating, excessive sleepiness, and loss of the sense of smell.
Monitoring symptoms at home can help ensure doctors have a complete overview of how your body is performing. For example, symptoms such as orthostatic hypotension, which is low blood pressure when you stand up after sitting or lying for a period of time, may not always be apparent after a single doctor’s visit.
Neurological and cognitive exam
To check for Parkinsonian symptoms, the doctor may check your muscle tone, eye movements, reflexes, strength, balance, and gait. The doctor may give you a pen and paper or an oral test to test for cognitive symptoms like memory loss or a decline in thinking abilities.
Knowing how long the symptoms have been going on can benefit your doctor. Doctors use the one-year rule for distinguishing between Parkinson's disease and dementia with Lewy bodies. If cognitive difficulties occur for more than a year before movement problems start, the diagnosis is the movement disorder Parkinson's disease dementia. Lewy body dementia is more appropriate if the cognitive symptoms start simultaneously or at least a year before the movement problems begin.
One of the first steps your doctor may take is tests to rule out other diagnoses. For example, they might give you a blood test to ensure your problem isn't due to an underactive thyroid.
Medications
Clinical trials continue to test the efficacy of various medicines in the treatment of Lewy body dementia. People with the condition often find that medications can slow the progression of cognitive decline, minimize Parkinsonian symptoms, and relieve other symptoms. These medications could include:
- Cholinesterase inhibitors to improve alertness and memory
- Parkinson's medications to reduce movement problems
- Medications to relieve other symptoms, like sleep disorders or movement problems
Consult a doctor before starting, changing, or stopping any medication for your condition or symptoms.
Therapy
Individual psychotherapy and family therapy
Alternative treatment options
When someone is diagnosed with LBD, it may affect them and their loved ones. Reaching out for help may be challenging if caregiving schedules or one's disability makes it challenging to leave home. Online therapy through a platform like BetterHelp can provide the support patients and caregivers seek to navigate the challenges they're experiencing.
A potential benefit of online therapy is attending sessions from the comfort of your home, or anywhere you have an internet connection. Whether fitting caregiving into a busy work schedule or trying to coordinate family sessions for multiple people, online therapy can be convenient.
Studies show that online therapy is effective, leading to a 50% improvement in symptoms of depression, generalized anxiety, and other mental health conditions and significantly decreasing the impact of stress and chronic fatigue.
Takeaway
While Lewy body dementia may refer to dementia with Lewy bodies or Parkinson’s disease, there are several signs that a person may be experiencing a condition under this classification. 3 of these signs may include:
- Significant changes in thinking, decision-making, and reasoning abilities
- Delirium-like symptoms that may cause difficulties with cognition
- Changes in movement, including slowness, tremors, and rigidity.
If you notice that you or a loved one is exhibiting these dementia symptoms, it is important to get support as soon as possible. A doctor may be able to provide a diagnosis and create a treatment plan that may help to alleviate your symptoms.
Dementia with Lewy bodies (DLB) is caused by a buildup of abnormal protein particles called Lewy bodies. These buildups are also associated with other conditions, including Parkinson’s disease. These buildups occur as the tissues of the brain decay. While some experts believe this build-up is connected to family history and genetics, there may be multiple reasons that someone could experience this process or develop DLB. DLB can affect a number of functions in the brain, including one’s ability to reason and think. In addition, DLB may create disturbances in REM sleep and cause slow movement.
The initial LBD symptoms can progress slowly, many experience significant challenges like struggles with thinking, changes in mood, and recurrent visual hallucinations. These hallucinations can take multiple forms, including seeing shapes, animals, and people that aren't there. LBD can also cause other forms of body dysfunction, including rapid changes in blood pressure and heart rate, struggles with digestion, and excessive sweating. These complications may result in inconvenience, dizziness, and constipation.
One of the biggest risk factors for the development of LBD is age. In addition, those experiencing high blood pressure or diabetes may also have an increased risk of developing LBD. While it may not be possible to prevent LBD, Alzheimer’s Research UK suggests several ways to keep one’s brain healthy in order to reduce risk.
- Avoid substances like tobacco and other nicotine products or overconsumption of alcohol
- Regularly exercise
- Maintain a healthy diet and weight
- Get regular blood pressure and cholesterol checks
- Socialize and engage in mentally stimulating hobbies
In addition, Alzheimer’s Research UK suggests that men are more likely to get a specific form of LBD known as dementia with Lewy bodies. Those with a family history of LBD may also be at a higher risk of developing these conditions.
Getting a diagnosis of LBD (sometimes incorrectly referred to as “Lewy bodies dementia”) requires the assistance of a medical professional. These professionals will typically ask what symptoms you are experiencing and request a copy of your medical history. After that, your doctor will likely run a variety of tests. These can include a single-photon emission computed tomography (SPECT) scan or a positron emission tomography (PET) scan. Imaging tests like the SPECT and PET can look at a brain region known as the basal ganglia in order to identify reduced dopamine transporter uptake. In addition, a sleep study can help to show whether a person is experiencing a common co-occurring condition, REM sleep behavior disorder.
According to the National Institute on Aging, there is currently no way to prevent or cure LBD. However, there are treatments that may help to alleviate certain symptoms. These treatments vary but may include therapeutic approaches, physical therapy, and certain types of medication. A medical team, often including mental health professionals, palliative care specialists, or physical therapists, can assist those experiencing LBD by creating a viable treatment plan. In addition, it may be helpful to seek out loved ones or support groups in order to create a sustainable social support network. Socialization can help to keep the brain active and in some cases may help to slow the progression of cognitive impairment.
Is Lewy body worse than Alzheimer's?
LBD (which includes dementia with Lewy bodies and Parkinson’s disease) and Alzheimer’s disease (sometimes incorrectly referred to as “Alzheimer’s dementia”) discuss many similarities. However, dementia with Lewy bodies (DLB) may have certain symptoms that could be considered worse than Alzheimer’s. One difference between LBD and Alzheimer’s is their early stages are the progression of hallucinations. Those with DLB may experience hallucinations as one of their initial symptoms, which may manifest as various shapes, animals, or people. In addition, rapid eye movement (REM) sleep disorder and movement disorders may also be more common with LBD.
There are several treatments that may help those experiencing LBD, including:
- Psychological Therapy: Therapeutic approaches like cognitive stimulation therapy can help those experiencing LBD and other forms of dementia improve their problem-solving, decision-making, language, and memory abilities. While some of these processes may have been automatic functions before, those with LBD may need assistance in order to ensure they can perform these abilities as their condition progresses.
- Occupational and Physical Therapy: Occupational therapy can help to provide support to those experiencing dementia by showing them how to adapt to their symptoms, complete household tasks, take care of body functions, and communicate with their care team and loved ones. Physical therapy, on the other hand, can help to address movement symptoms, such as problems with balance and shuffling gait.
- Medication: Certain medications like cholinesterase inhibitors may be used as treatments for the cognitive problems associated with Lewy body dementia. In addition, selective serotonin reuptake inhibitors have been used for depressive symptoms, and antipsychotic medications have been used in the past to combat hallucinatory symptoms. However, research suggests these antipsychotics may cause an adverse reaction in a significant number of patients.
While there may not be a proven way to ensure that LBD is prevented, there are certain lifestyle changes and behaviors that may improve brain health. Here are a few actions that may be helpful.
- Eating a healthy and balanced diet that provides a significant amount of nutrients and vitamins
- Seeking assistance for any physical or mental health conditions that have not been treated
- Frequently exercising and engaging in physical activities that you enjoy
- Keeping in contact with friends and family
- Finding ways to relieve stress
- Avoiding the misuse of substances like alcohol
- Keeping your mental abilities honed through activities like adult education
In addition to keeping your brain healthy, it's also important to get regular check ups with your primary care physician. These professionals can help to identify the symptoms of LBD early, which can allow you to get started on a treatment plan.
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