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
How Can We Support The Sleep/wake Cycle Of Dlb
For people with DLB who are confused about the day-night cycle, some daily strategies can be helpful. At night, starting a lights out routine that happens at the same hour every day, where all curtains are closed and lights are turned off, can help the person understand that it is sleep time. During the day, opening the curtains, allowing patients to spend as much time in the daylight as possible, avoiding naps, and organizing stimulating activities, can be helpful. Having lots of calendars and clocks in every room might also help a person with DLB be less confused about the time of day.
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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Lewy Bodies: More Than Lbd
LBD is characterized by the presence of Lewy bodies in the nerve cells of the brain, meaning that LBD patients have Lewy bodies in the brain.2 However, Lewy bodies are also common with other conditions, such as Alzheimer’s and Parkinsons disease. In fact, most people with PD also have Lewy bodies in their brain. However, even if they have Lewy bodies, not all Parkinsons patients will also develop LBD.2
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Understanding Lewy Body Dementia
Lewy body dementia consists of two different conditions: dementia with Lewy bodies and Parkinson’s disease dementia. The two share many of the same symptoms and may often be considered to be the same.
However, one significant factor in;how Lewy body dementia progresses is related to which disease is actually present. In Parkinson’s disease dementia, the physical challenges are usually evident first, while in dementia with Lewy bodies, cognitive changes may appear earlier than, about the same time, or shortly after,;the physical changes develop.
Clinical Manifestations And Diagnostic Criteria
Clinically, DLB is marked by four core symptoms: fluctuating cognition, parkinsonism, visual hallucinations, RBD, and cognitive impairment across multiple domains with moderate memory impairment . DLB is a heterogenous disease. Cluster analysis yielded 3 different groups: cognitive-predominant , neuropsychotic-dominant , and parkinson-predominant . DLB patients with mild cognitive impairment perform worse on visuospatial function and letter fluency tests and better on episodic memory tests than AD-MCI . Cognitive impairment in PD patients being more common in the akinetic/rigid phenotype than in tremor-dominant and mixed phenotypes is similar in quality to what is observed in DLB , but the rate of cognitive decline is faster in DLB than in PDD and AD , and shows more severely impaired frontal and temporal area-associated cognitive profiles . The clinical overlaps and dissimilarities between DLB and PDD have been summarized recently .
Table 1: Clinical overlap and dissimilarities between dementia with Lewy bodies and Parkinson disease with dementia .View Table 1
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.
What Is Parkinsons Disease
PD is a chronic, neurodegenerative movement disorder. PD affects 1 out of every 100 individuals over the age of 601, and patients commonly experience muscle rigidity, changes in speech and walking, and tremors. Some studies suggest that having PD also increases your risk of developing LBD, but most patients have only one of these conditions.2
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What You Need To Know
- Lewy body dementia is a form of progressive dementia that affects a persons ability to think, reason, and process information.
- Diagnosing Lewy body dementia can be challenging; an estimated 1.4 million Americans are living with the disease.
- LBD has three features that distinguish it from other forms of dementia:
- Fluctuating effects on mental functioning, particularly alertness and attention, which may resemble delirium
- Recurrent visual hallucinations
- Parkinson-like movement symptoms, such as rigidity and lack of spontaneous movement.
Lewy bodies are clumps of abnormal protein particles that, for reasons that are not fully understood, accumulate in the brain. These deposits cause a form of dementia called Lewy body dementia, or LBD which is what the late actor and comedian Robin Williams suffered from.
LBD is not the same as Parkinsons, but the two are closely related: LBD causes some or all of the motor symptoms of Parkinsons. More than 1 million people in the U.S. are affected by Lewy body dementia, according to the Lewy Body Dementia Association.
Two Ways Lewy Bodies Affect The Brain
Another well known and beloved actor is closely associated with Lewy bodies. Michael J. Fox was diagnosed with Parkinsons disease in 1991. He was only 29 years old. Fewer than 20% of Parkinsons diagnoses;are this early onset type. However, the symptoms of early onset Parkinsons disease seem to progress more slowly than otherwise.
Fox took a break from acting in 2000 to start The Michael J. Fox Foundation for Parkinsons Research. However, it was not because his condition left him exhausted. He works tirelessly to advance research and to raise public awareness about Parkinsons. His candor, his willingness to show how the disease has affected him, has done a lot to break down stigma surrounding the condition. Even now his disease doesnt seem to be dementia, and we hope that it will not. You can see how the disease affects him in; the video below.
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What Is Dementia With Lewy Bodies
Dementia with Lewy Bodies may account for 10-15 per cent;of all cases of dementia. DLB can;be diagnosed wrongly and is often;mistaken for Alzheimer’s disease.;
DLB is sometimes known by other names.;These include Lewy body dementia, Lewy;body variant of Alzheimer’s disease, diffuse;Lewy body disease and cortical Lewy body;disease. All these terms refer to;the;same;condition.
What a short video about dementia with Lewy bodies:
How Is Lewy Body Dementia Diagnosed
There isn’t one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be specialist such as a neurologist. The doctor will
- Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
- Do physical and neurological exams
- Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
- Do neuropsychological tests to evaluate memory and other cognitive functions
LBD can be hard to diagnose, because Parkinson’s disease and Alzheimer’s disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.
It’s also important to know which type of LBD a person has, so the doctor can treat that type’s particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:
- If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
- If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson’s disease dementia
How Does Lewy Body Dementia Differ From Alzheimers Disease
Most are familiar with Alzheimerâs disease, but chances are, if you ask anyone on the street what Lewy body dementia is, they wonât have a clue. The prevalence of dementia with Lewy bodies is unknown, but dementia experts believe that LBD accounts for between 10% and 15% of all dementia cases.
As with other forms of dementia, LBD is a progressive brain disorder. It occurs when abnormal deposits of a protein called alpha-synuclein build up in the areas of the brain responsible for regulating behavior, cognition and movement. These deposits are called Lewy bodies. According to the Michael J. Fox Foundation for Parkinsonâs Research, there is compelling evidence from recent studies that alpha-synuclein may also play a role in the development of both familial and sporadic cases of Parkinson’s disease. In fact, LBD shares symptoms with both Alzheimerâs and Parkinsonâs disease.
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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The Difference Between Parkinson’s Disease And Lewy Body Dementia
One of the most confusing concepts to explain in the clinic is the difference between Parkinson’s Disease, Parkinson’s Disease Dementia and Lewy Body Dementia. Ultimately people with Parkinson’s can look very similar with motor and non-motor problems. This is particularly tricky when PwP first present but the easiest way to consider Lewy Body Dementia is like having a very aggressive progression of Parkinson’s where patients are dementing in the first year of their condition whereas this process is much slower when patients develop Parkinson’s Disease Dementia. Indeed, clinically Lewy Body Dementia patients look like they have a cross between Parkinson’s and Alzheimer’s, which is actually close to what is seen down the microscope when researchers study the brain. Understanding the differences between Parkinson’s Disease and Lewy Body Dementia is not only difficult for patients and their families but has led some professional groups to try and lump all of these patients together under one umbrella, which probably does little to help individual families appreciate what the future holds.
Hopefully this video will help you to gain a more complete understanding of the differences between Parkinson’s Disease, Parkinson’s Disease Dementia and Lewy Body Dementia.
For Carers Family And Friends
Living with or caring for someone with dementia can be very difficult. Try to encourage, provide stimulation and help the person maintain as much independence as possible.
For suggestions that may help minimise confusion and make daily activities easier see:
- Mild memory and cognitive problems – Advice for carers, family and friends
Content last reviewed:;May 2018
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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.
Lewy Body Dementia: A Common Yet Underdiagnosed Dementia
While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.
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Treatment Of Pdd And Dlb
Unfortunately, since both types of Lewy Body Dementia often display similar symptoms, patients suffering from either PDD of DLB can get misdiagnosed and subsequently prescribed the incorrect medication and method of treatment. Caregivers and medical professionals alike can increase their understanding of symptoms for each disease to help them more quickly and accurately diagnose and treat each one.
The Lewy Body Dementia Resource Center provides literature, support groups, and help for caregivers grappling with care and treatment of a loved one who has Lewy Body Dementia. Our helpline is available 12 hours a day, 7 days a week for caregivers who have questions or are in need of support. Our online resource center seeks to bring awareness and support to caregivers of those suffering with Lewy Body Dementia. Please dont hesitate to reach out to us.
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.