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.
Approximate Lewy Body Dementia Phases Symptoms And Considerations
Lewy Body Dementia Stage 1 Possibilities
Most caregivers are concerned/worried that something is not right. Symptoms from later stages can also appear this early on the continuum. At the end of this phase, cognitive impairment is difficult to deny.
Symptoms and subtle changes may include:
- Increased daytime sleep: two-plus hours
- May accuse spouse of infidelity
Lewy Body Dementia Stage 2 Possibilities
Caregivers consult with an elder law attorney by this point: at very least have a Power of Attorney and Medical Power of Attorney document on the patient. Protect assets: family, friends, caregivers may be able to take financial advantage of LO. Caregivers need to familiarize themselves with all finances and assets to possibly consult with a financial advisor.
Symptoms are usually clearer by this point:
Increased difficulty with:
Lewy Body Dementia Stage 3 Possibilities
Lewy Body Dementia Stage 4 Possibilities
Lewy Body Dementia Stage 5 Possibilities
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Clinical Features And Diagnostic Criteria Of Dlb
Table 1 Clinical overlap and dissimilarities between dementia with Lewy bodies and Parkinson disease with dementia
Supporting clinical features for the diagnosis of probable or possible DLB are repeated falls, syncopes, hyposmia, severe autonomic dysfunction, hypersomnia, hallucinations in non-visual modalities, apathy, depression, and severe sensitivity to antipsychotic agents . However, since these changes also occur in advanced PD, they cannot differentiate DLB from PDD, e.g., the prevalence of neuroleptic sensitivity does not differ significantly between them .
A diagnosis of clinically probable DLB requires two or more core clinical features to be present, with or without indicative biomarkers, or the presence of only one core clinical feature but with one or more indicative biomarkers . Although the diagnostic specificity of these criteria is high , the sensitivity can be low , improving with additional supporting features such as biomarkers . A recent meta-analysis reported a pooled sensitivity, specificity, and accuracy of 60.2% , 93.8% , and 79.7% , respectively, for the diagnostic criteria of DLB . Thus, currently, approximately 20% of DLB diagnoses are incorrect .
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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.
How Is Lewy Body Disease Diagnosed
This type of dementia is diagnosed by taking a careful history of the pattern of symptoms, and by excluding other possible causes such as Vascular dementia and Alzheimers disease. A brain scan may reveal brain degeneration, but the Lewy bodies can only be identified by examination of brain tissue after death.
Lewy body disease is similar to Alzheimers disease in many ways, and in the past it has sometimes been difficult to distinguish the two. It has only recently been accepted as a disease in its own right. It can occur by itself or together with Alzheimers disease and/or Vascular dementia. It may be hard to distinguish Lewy body disease from Parkinsons disease, and some people with Parkinsons disease develop a dementia which is similar to that seen in Lewy body disease.
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How Is Parkinson Disease Treated
Parkinson disease cant be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
How Is Lewy Body Dementia Different From Alzheimers
Alzheimers disease is the most common type of dementia, and LBD is the second most common. Because of the overlap in symptoms, it can be difficult to diagnose one or the other initially.
Both diseases are caused by sticky protein buildups in the brain. However, with Alzheimers disease, these protein build ups cause amyloid plaques, caused by the amyloid protein, and neurofibrillary tangles caused by the tau protein.
When these proteins accumulate, they interfere with the brain and bodys sense of communication, affecting cognition, movement, and behavior.
One of the key differences between the two diseases is hallucinations.
Hallucinations are common early on in people with LBD, but take a long time to develop for people with Alzheimers disease.
The other key indicators somebody has LBD rather than Alzheimers is developing Parkinsons-like tremors and muscle rigidity, and difficulty sleeping.
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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.
Find Time To Care For Yourself
As a caregiver, it is critical for you to take care of to maintain your own health and well-being. You may be at increased risk for poor sleep, depression, or illness as a result of your responsibilities. Watch for signs of physical or emotional fatigue such as irritability, withdrawal from friends and family, and changes in appetite or weight.
All caregivers need time away from caregiving responsibilities to maintain their well-being. Learn to accept help when its offered, and learn to ask family and friends for support. One option is professional respite care, which can be obtained through home care agencies and adult day programs. Similarly, friends or family can come to the home or take the person with LBD on an outing to give you a break.
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Lewy Body Dementia Signs And Symptoms
There are many signs and symptoms of LBD. A major hallmark is cognitive impairment. It is defined in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders as cognitive decline in one or more areas . People with problems in these areas might be forgetful, have problems paying attention, have trouble with problem-solving, be unable to learn new facts or skills, have difficulty with speaking or forming sentences, or have behavioral changes. These symptoms can range from mild to major, and in order to make the diagnosis, they must significantly impair a persons day-to-day functioning.
Cognitive impairment isnt the only hallmark of LBD. People with dementia with Lewy bodies and PDD may present very differently because of how the Lewy bodies deposit in the brain.
Dementia with Lewy bodies is characterized by three main features, according to the DSM-5:
- Problems with cognition
- Spontaneous features of parkinsonism , which begin after the cognitive symptoms appear
Other features that can suggest dementia with Lewy bodies are:
- Rapid eye movement sleep behavior disorder
- Sensitivity to antipsychotic medications
PDD symptoms are similar, but the timing is different. The important difference is that in PDD, parkinsonian movement symptoms start before cognitive symptoms and dementia appear.
Hallmark symptoms of both diseases include:
What Is Vascular Dementia
Vascular dementia is the second most common type of dementia in the UK after Alzheimers disease. It occurs when the brain is damaged due to a lack of blood flow.
Sometimes people have both vascular dementia and Alzheimers, giving them a diagnosis of mixed dementia.
If the vascular system within the brain becomes damaged so that the blood vessels leak or become blocked then blood cannot reach the brain cells and they will eventually die.
This death of brain cells can cause problems with memory, thinking or reasoning, and when these cognitive problems are bad enough to impact on daily life, it is known as vascular dementia.
Dementia symptoms specific to vascular dementia include stroke-like symptoms, suchas as muscle weakness, movement and thinking problems and mood changes, such as depression.
There are several different types of vascular dementia, due to the varying levels of damage on the affected part of the brain.
They include stroke-related dementia, single-infarct and multi-infarct dementia and subcortical vascular dementia.
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How Lewy Body Dementia Differs From Other Types Of Dementia
Dementia is a term that describes the gradual loss of the ability to think, reason or remember. The most common form of dementia in the U.S. is associated with Alzheimers disease, but can also be caused by Lewy body dementia, frontotemporal dementia, and , among others. Although they all have dementia in common, the symptoms of these diseases differ because they affect different parts of the brain.
Lewy body dementia affects many parts of the brain, starting with the outer layer of the brain, called the gray matter or cerebral cortex. The cerebral cortex is responsible for language, thinking, perception and judgment. This is why some of the earlier symptoms of Lewy body dementia include changes in visual perception, delusions or , difficulty paying attention, and misidentifying objects.
As other parts of the brain become affected, more symptoms appear, such as difficulty forming new memories, changes in behavior, difficulty sleeping or excessive sleepiness, and difficulty moving and maintaining balance.
Although overall Lewy body dementia symptoms are similar to other types of dementia like Alzheimers disease or frontotemporal dementia, there are some key differences. For example, early symptoms of Alzheimers disease are or getting lost in familiar places. The earliest symptoms among people with frontotemporal dementia tend to be changes in personality or the inability to bring out the correct words.
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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 Alzheimers 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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Deficiency Of Parkinsons Disease Society Brain Bank Criteria
The clinical diagnosis of PD has been established in the past 30 years mainly based on the UK-PDSBB, first proposed in 1988. These were later validated in two clinico-pathological studies carried out at Queen Square, in Hughes original study in 1992 and its replication published in 2001 and 2002,,. The criteria were created using the clinical notes and data retrieved from general practitioner files and their retrospective correlation with pathological findings. From todays point of view, it is therefore questionable, whether these criteria will resist the light of todays molecular genetics and molecular biology state of the art.
The key players in this field are currently the numbers of gene variants, causal or associated with the manifestation of typical PD, combined with epigenetic factors, and Braaks concept formulated almost 20 years ago,,. Nevertheless, thehotspot should be the observations that the pathological neurodegenerative process might manifest in a quite different way than usually described and known ,,,,,.
Table 2 Arguments against the current concept of Lewy body diseases.
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Be Careful Not To Confuse Lewy Body Dementia With Psychiatric Disease Or Parkinsons Disease
Caused by an abnormal protein Symptoms similar to other diseases
|Professor Park Ki-hyung|
Lewy body dementia can show similar symptoms to Parkinsons disease, so be careful not to confuse it. In both diseases, body movement is slow and gait is bad, but Lewy body dementia has little hand tremor.
Professor Park Gi-hyung of the Department of Neurology at Gachon University Gil Hospital explained that Lewy body dementia and Parkinsons disease are diseases caused by a protein called alpha synnuclein that damages brain cells.
Lewy body dementia is a disease caused by the accumulation of abnormal protein clumps in the cerebral cortex and brainstem, resulting in brain cell damage. It is known as the second most dementia after Alzheimers disease dementia.
Lewy body dementia is similar to, but different from, Parkinsons disease. This is because Parkinsons symptoms also appear in patients with Lewy body dementia. However, there are differences from common Parkinsons disease. Parkinsons disease often begins with tremors on one side of the hand, often resulting in slow movements and a gait that is strident. However, in many cases, the symptoms of Parkinsons symptoms of Lewy body dementia and hand tremor are not seen.
In addition, dopamine, a treatment for Parkinsons disease, is not effective for patients with Lewy body dementia.
Finally, the main symptom of Lewy body dementia is Parkinsonian symptoms. Parkinsonian symptoms of dementia with Lewy bodies are as described above.
Lewy Body Dementia: Causes And Symptoms
Lewy body dementia is an umbrella term for two related types of dementia dementia with Lewy bodies and Parkinsons disease dementia . Dementia is a disease that progressively impairs a persons ability to think, reason, remember, and function. Although these two conditions have overlapping features, there are also important distinctions. Understanding LBD causes and symptoms, as well as how its two subtypes, dementia with Lewy bodies and PDD, differ from one another is critical for proper diagnoses and shortening the time to start treatment.
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Model Building Based On Machine
To better distinguish PD patients from healthy controls, three well-established machine-learning algorithms were performed using tenfold cross-validation by R to construct models using the abundances of genus or genes. In the process of model construction, the combined amplicon or metagenomic data were first divided into ten parts. Then nine parts were randomly selected and used for model construction, and then the remaining independent part was used for model validation. After that, the ROC curve and AUC were used to evaluate the model performance. The importance of each feature in the model was assessed by the R package randomForest. Then, the features were sorted by importance, and different numbers of features were selected for modeling to determine the most concise model. The detailed code and documentation for model building are available on GitHub .
The Presence Of Lewy Bodies
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. However, Lewy bodies are also common with other conditions, such as Alzheimer’s and Parkinsons disease.2
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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What Other Things Help
There are various ways to help a person with DLB. Speech therapy may help improve communication between people with DLB and others. Physical therapy may help strengthen and stretch stiff muscles and help to prevent falls.
Research has shown that physical exercise helps to enhance brain health and improves mood and general fitness. A balanced diet, enough sleep, and limited alcohol intake are other important ways to promote good brain health. Other illnesses that affect the brain, such as diabetes, high blood pressure, and high cholesterol, should also be treated if present.