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.
Summarizing The Difference Between Parkinson’s Disease And Lewy Body Dementia
Because Parkinson’s disease and Lewy body dementia are both caused by the presence of Lewy bodies in the brain and result in similar symptoms, it can be confusing to understand the difference. Here’s a quick summary:
Lewy body dementia is a blanket term referring to dementia caused by the presence of Lewy bodies. There are two types of Lewy body dementia:
- Dementia with Lewy bodies
- Parkinson’s disease dementia
Parkinson’s disease is a progressive brain disorder that impacts movement, coordination and balance. The term Parkinson’s disease doesnt imply that dementia is present, and not all patients with Parkinson’s get dementia. However, those who have Parkinson’s are almost six times more likely to develop cognitive impairment compared to those of the same age without Parkinson’s. People with Parkinson’s disease who develop dementia are said to have Parkinson’s disease dementia.
At this time, there’s no prevention or cure for Parkinson’s disease and Lewy body dementia. Doctors can recommend treatments and therapies to help ease symptoms and improve quality of life.
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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Is There Any Way To Prevent Lewys Body Dementia
There is no proven way to prevent the onset of LBD or any form of dementia, but there are certain lifestyle habits you can adopt to improve brain health for as long as possible, Dr. Caccappolo says.
These include reducing / managing stress as much as possible, following a regular sleep routine, maintaining a healthy diet, exercising where possible, staying socially and intellectually active, and managing overall health, he says.
Can Imaging Tests Diagnose Lewy Body Dementia
Imaging tests, such as computed tomography or magnetic resonance imaging , are done to rule out other causes of dementia such as brain tumors, brain bleeds, stroke, hydrocephalus or other structural causes. Imaging studies for Lewy body dementia are usually normal. The only way to make an absolute diagnosis of LBD is by examining the brain at autopsy.
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What Causes Lewy Body Dementia
The causes of LBD are not yet well understood, but research is ongoing in this area. There are probably multiple factors involved, including genetic and environmental risk factors that combine with natural aging processes to make someone susceptible to LBD.
For more information, visit www.lbda.org.
Modified with permission from the Lewy Body Dementia Association
To learn more about motor symptoms related to Parkinsons, visit here.
To learn more about non-motor symptoms related to Parkinsons, visit here.
Do You Die From Pd Dementia
People with Parkinsons-related dementia often want to know how the disease can impact their lifespan. While people with Parkinsons can expect a similar lifespan to the general population, studies show both Parkinsons disease dementia and Lewy body dementia can shorten lifespan, generally due to medical complications from the disease, rather than the disease itself.
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Building A Lewy Body Dementia Care Team
After receiving a diagnosis, a person with LBD may benefit from seeing a neurologist who specializes in dementia and/or movement disorders. Your primary doctor can work with other professionals to follow your treatment plan. Depending on an individual’s particular symptoms, physical, speech, and occupational therapists, as well as mental health and palliative care specialists, can be helpful.
Support groups are another valuable resource for people with LBD and their caregivers. Sharing experiences and tips with others in the same situation can help people find practical solutions to day-to-day challenges and get emotional and social support.
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.
Slowing the progression of symptoms
The same healthy lifestyle changes that are used to prevent dementia can also be useful in slowing the advancement of LBD symptoms.
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Treating Movement Symptoms In Lewy Body Dementia
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.
What Is Lewy Body Dementia
LBD is a chronic, neurodegenerative cognitive disorder, and is the 3rd most common form of dementia.3 Unlike most other forms of dementia, people with LBD have Lewy bodies in the brain. Lewy bodies are abnormally-folded proteins found in the nerve cells of the brain.2 Patients with LBD may experience memory/cognitive problems, visual hallucinations, and Parkinsonism symptoms.4
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How Is Dementia In Lewys Body Diagnosed
Part of the reason why LBD is so difficult to diagnose is because there is no definitive test for LBD, says Dr. Caccappolo. Instead, physicians often have to rule out other conditions when assessing clinical symptoms, laboratory findings, brain imaging, and neuropsychological tests, he adds. Often this requires the expertise of a geriatric psychiatrist, neurologist, or neuropsychologist.
Based on the findings, a doctor may make a diagnosis of LBD, however such as Alzheimers disease, it is currently not possible to confirm it 100% without an autopsy on the brain, National Institute of Aging. Thats a problem because some of the drugs used to treat Alzheimers and Parkinsons disease can make symptoms worse, Trinh says. For example carbidopa-levodopa, which is typically used to treat Parkinsons symptoms such as muscle stiffness and slow movement, may increase confusion and hallucinations in LBD patients.
The good news is the National Institute on Aging arguments that doctors are becoming more accurate in diagnosing LBD and recognizing symptoms much earlier so that their patients receive the right treatment.
How Is Lewy Body Dementia Treated
While there is no cure for LBD, there are medications that can be very helpful for managing symptoms, says Caccappolo. For example, she finds that treatments like:
- Cholinesterase inhibitors can help with agitation, apathy, hallucinations and memory changes.
- Antidepressants like SSRIs can help with mood changes.
- Cognitive remediation therapy, which guides patients in cognitively stimulating exercises, can somewhat improve memory and executive functioning.
Physical and/or occupational therapy can also assist in preventing falls and helping people maintain physical autonomy in their day-to-day tasks for as long as possible, according to Skinner. While general counseling, can help a person come to terms with their diagnosis, discuss their feelings, or navigate depression or anxiety.
With her clients, Skinner also recommends that they stay as active as they can, physically, mentally, and socially, whether thats following a safe, doctor-approved exercise routine, keeping in touch with family, or joining a local club. Engaging in meaningful activities can be enjoyable and increase self-esteem and confidence.
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Rem Sleep Behavior Disorder
LBD: People with LBD sometimes experience REM sleep behavior disorder, a dysfunction where they physically act out the situations in their dreams. Some research suggests that REM sleep behavior disorder can be one of the earlier predictors of LBD.
Alzheimers:REM sleep behavior disorder is not typically present in Alzheimers, although other types of sleep disturbances may occur.
What Are The Stages Of Lewy Body Disease
What are the seven stages of Lewy body dementia?
- Stage one: Absolutely normal stage. …
- Stage two: Very mild symptoms. …
- Stage three: Symptoms are still mild and may include. …
- Stage four: Patients may usually have confirmed diagnosis at this stage. …
- Stage five: Symptoms are usually moderately severe. …
- Stage six: This usually lasts for 2.5 years.
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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:
- 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
Epidemiology And Natural History Of Dlb And Pdd
Approximately 12% of those aged above 65 years are diagnosed with DLB worldwide , affecting approximately 5% of all dementia cases in those over the age of 75 . Its incidence is 0.71.4 new cases/100,000 person-years or 3.5/100,000 person-years . For PDD, the cumulative prevalence is of 75% of PD patients surviving more than 10 years , 83% after 20 years , and up to 95% by age 90 years , with an overall prevalence of 31.1% and incidence rates from 0.43 to 1.13/100,000 person-years , indicating that, annually, approximately 10% of a PD population will develop dementia . The data concerning age at disease or dementia onset are highly variable. Whereas in the Olmsted County study DLB patients were younger at symptom onset than those with PDD and had more hallucinations and cognitive fluctuations, others have reported younger age at disease onset in PDD , or no essential differences between disorders .
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What Complications Are Associated With Medications Used To Treat Lewy Body Dementia
Up to 50% of people living with Lewy body dementia can have severe side effects when treated with certain antipsychotic medications. These are known as the typical or traditional antipsychotics and include such drugs as thoridazine, haloperidol, chlorpromazine and perphenazine. This class of older, first-generation antipsychotics can cause sedation and make cognitive symptoms and movement problems worse. A life-threatening reaction to an antipsychotic medication, called neuroleptic malignant syndrome, is possible. Symptoms include rigid muscles, changing blood pressure, high fever, confusion and fast heart rate. Contact your healthcare provider immediately if you or your loved are taking an antipsychotic and develop these symptoms.
Visual hallucinations and behavioral changes may be treated with the newer, atypical antipsychotic medications pimavanserin , quetiapine or clozapine . However, because all antipsychotic medications both older, typical medications and newer atypical medications can increase the risk of death in elderly patients with dementia, you and your healthcare provider should carefully discuss the risks and benefits and using these medications.
Other medications, like antidepressants or sedative antihistamines, may increase confusion in people with LBD.
How Can We Manage Hallucinations
It may not be necessary to treat all hallucinations of a person with DLB. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or his/her surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, most medications used to treat hallucinations may make movement symptoms worse.
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What Should I Do If I Notice Signs Of Cognitive Impairment In Myself Or Someone I Love
Early detection and proper diagnosis can help you find the best treatments to manage your worrying symptoms as soon as possible. If a person has experienced changes in cognitive or motor activity for a few months or longer, I recommend setting aside time for a neurologist, Caccappolo says.
Getting the right diagnosis can also allow the patient and their caregivers to learn about the symptoms of LBD, so that they can better accept aspects of the disease, especially those who are not under patient control, adds Caccappolo.
It is a relief for many to know why worrying symptoms or behaviors occur. From there, appropriate health care decisions and lifestyle arrangements can be made to maximize the quality of life of LBD patients and their caregivers.
Overall, this process can be difficult to navigate, and thats why organizations like it Lewy Body Dementia Association and Lewy Body Dementia Resource Center you have support group directories and helplines to help along the way. LBD may still be shrouded in mystery, but entire communities and scientists are working together to make sure no one is left in the dark.
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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Treatment And Care For Lewy Body Dementia
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.
What Are The 7 Stages Of Lewy Body Dementia
WHAT ARE THE 7 STAGES OF 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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Is There Any Way To Prevent Lewy Body Dementia
Theres no proven way to prevent the onset of LBD or any form of dementia, but there are certain lifestyle habits you can adopt to boost your brain health for as long as possible, according to Dr. Caccappolo.
These include decreasing/managing stress as much as possible, following a regular sleep routine, maintaining a healthy diet, exercising when possible, staying socially and intellectually active, and managing overall health, she says.