Understand Behavioral Changes In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Hallucinations and delusions are among the biggest challenges for LBD caregivers. The person with LBD may not understand or accept that the hallucinations are not real and may become agitated or anxious. Instead of arguing, caregivers can help by responding to the fears expressed. By tuning in to the person’s emotions, caregivers can offer empathy and concern, maintain the person’s dignity, and limit further tension.
Caregivers can try a variety of strategies to handle such challenging behaviors. Some behavioral problems can be managed by making changes in the person’s environment and/or treating medical conditions. Other problems may require medication.
Itâs also common for people with LBD to have difficulty falling asleep. Certain sleep problems can be addressed without medications. Increasing daytime exercise or activities and avoiding lengthy or frequent naps can promote better sleep. Avoiding alcohol, caffeine, or chocolate late in the day can help, too. Some over-the-counter medications can also affect sleep, so review all medications and supplements with a physician.
Types Of Lewy Body Dementia
It’s important to know which type of LBD a person has, both to tailor treatment to particular symptoms and to understand how the disease will likely progress. Clinicians and researchers use the “one-year rule” to help make a diagnosis. If cognitive symptoms appear at the same time as or at least a year before movement problems, the diagnosis is dementia with Lewy bodies. If cognitive problems develop more than a year after the onset of movement problems, the diagnosis is Parkinson’s disease dementia.
Regardless of the initial symptoms, over time, people with either type of LBD often develop similar symptoms, due to the presence of Lewy bodies in the brain. But there are some differences. For example, dementia with Lewy bodies may progress more quickly than Parkinson’s disease dementia.
Parkinsons Disease: Causes Symptoms And Treatments
Parkinsons disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.
Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.
While virtually anyone could be at risk for developing Parkinsons, some research studies suggest this disease affects more men than women. Its unclear why, but studies are underway to understand factors that may increase a persons risk. One clear risk is age: Although most people with Parkinsons first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinsons are often, but not always, inherited, and some forms have been linked to specific gene mutations.
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Acknowledgments And Conflict Of Interest Disclosure
Data in this manuscript are original and were generated for the purpose of this study. Photomicrographs were taken from tissue provided by the Newcastle Brain Tissue Resource, which is funded in part by a grant from the UK Medical Research Council , by Brains for Dementia research, a joint venture between Alzheimers Society and Alzheimers Research UK and by the NIHR Newcastle Biomedical Research Centre awarded to the Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. DLB research is supported by NIHR Newcastle Biomedical Research Centre in Ageing and Long-Term Conditions. LW is funded by the Alzheimers Society. The authors have no conflicts of interest to declare.
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An Insufficient Mainstay For The Formulation Of Pdd Criteria
PDD as a novel subtype of the LBD has been gradually recognized in the nineties of the last century. The principal reason which led to its identification waswithout any doubtthe introduction of novel drugs into the PD treatment armamentarium, hand-in-hand with the introduction of the treatment of late, advanced, and complicated PD, i.e. deep brain stimulation and subcutaneous apomorphine infusions. Both these approaches led to substantially longer survival of PD patients, so the cases with manifest dementia appeared. In other words, dementia related to PD was unmasked.
When Emre in 2003 discussed the concept of PDD on a more extensive basis, he introduced two most important risk factors: older age as such, and older age at the moment of motor symptoms manifestation. The detailed description of typical PDD phenotype together with the first suggestion of clinical diagnostic criteria was published in 2007. International experts, led by Emre, indeed performed a critical meta-analysis of published studies. They particularly extracted the neuropsychological manifestations of the typical PDD cognitive disorder, i.e. the progressive executive dysfunction, only later accompanied by the general cognitive dysfunction. They also summarized the results of 24 clinicalpathological studies, published in 19792005.
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What Is The Treatment For Dementia With Lewy Bodies
There is no cure or treatment that stops or slows dementia with Lewy bodies. Treatment is aimed at relieving symptoms and delaying loss of mental abilities for as long as possible.
An individual with dementia with Lewy bodies should always be under medical care. Much of the day-to-day care, however, is handled by family caregivers. Medical care should focus on optimizing the individualâs health, safety, and quality of life while helping family members cope with the many challenges of caring for a loved one with dementia with Lewy bodies.
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The 6 Stages Of Parkinsons And Lewy Body Disease
In 2003, Heiko Braak identified a pattern of Lewy body deposition, in the synucleinopathies , which include Parkinsons Disease , Multiple Systems Atrophy , Progressive Supra-nuclear Palsy and Dementia .
The pattern that he identified has been termed the Braak Staging of Lewy Body inclusions. More current research shows that Lewy Body pathology can spread from one area of the nervous system to another, and its conceivable that this happens in a prion-like fashion. There are also some studies that show alpha-synuclein is not only just an intracellular protein but is extracellular as well, which could explain to some degree, the progression to other areas of the brain.
The first three stages of Braaks staging, are largely asymptomaticto the uninformed individual.
In stage 1, inclusion bodies begin accumulating in the olfactory bulb and a part of our brainstem called the Vagus Nucleus. Symptoms at this point may include a change in the ability to smell and taste, as well as a constellation of symptoms we call autonomic symptoms, which are often casually related to aging. The symptoms may, or may not include: constipation, sexual dysfunction, dry eyes, dry skin, light-headedness, high blood pressure, insulin resistance, swelling of the hands and feet, bladder dysfunction, an increase in heart rate or arrhythmia, dizziness when getting out of a chair or bed, etc.
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Selective Vulnerability Due To Anatomical Configuration Of Neurons
The selective vulnerability of specific neuronal populations is considered to be one of the factors involved in the specific distribution of pathological changes and the resulting clinical phenotype. The anatomical configuration of neurons is thought to be one of its causes. More recent neuro-histological studies support the theory that axonal involvement is critical. Syn aggregation starts in the axonal compartment and progresses back towards the cell body, axons become dystrophic with alterations in axonal transport, and this ultimately leads to cell death,.
It has been shown in PD cases that loss of dopamine is more profound at the axon terminals in the caudate and putamen than is the loss of nigral neurons it suggests that degeneration is greatest in distal parts of the cell. Other neurons preferentially affected in PD, PDD, and DLB also show a similar anatomical configuration. These are mainly cholinergic cells of the nucleus basalis of Meynert that are strongly implicated in the pathogenesis of dementia in PD or serotonergic cells of the raphe nucleus, which also have extensive axon projections. Similarly, the long unmyelinated axons of the peripheral autonomic nervous system may explain the early and prominent involvement of autonomic symptoms in both DLB and PD.
Discuss Lewy Body Dementia Diagnosis With Family
Not all family members may understand or accept LBD at the same time. This can create conflict. Some adult children may deny that their parent has a problem, while others may be supportive. It can take a while to learn new roles and responsibilities.
Family members who visit occasionally may not see the symptoms that primary caregivers see daily and may underestimate or minimize your responsibilities or stress. Professional counselors can help provide guidance on how families can work together to manage LBD.
Although LBD and Alzheimer’s disease are different disorders, they share similar family concerns. For more information, read Helping Family and Friends Understand Alzheimer’s Disease and Helping Children Understand Alzheimer’s Disease.
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Wait So What Is Parkinsonism
Parkinsonism refers to the motor symptoms that are typically associated with PD, such as tremors, stiffness, and walking/balance problems. Both PD and LBD are forms of Parkinsonism, meaning that PD patients and LBD patients may experience these motor symptoms.2 Because the Parkinsonism motor symptoms of PD and LBD can be very similar, it can be difficult to differentiate between the two conditions.
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Signs And Symptoms Of Lewy Body Disease
Along with the symptoms described above, other health conditions may indicate the presence of Lewy body disease. These include:
- other medical tests as requested by a doctor or medical specialist.
Even with these tests, a definitive diagnosis may not be possible at the first assessment.
Getting a diagnosis can be more challenging when the physical signs are not as evident. Often the person with symptoms:
- may not agree with the concerns of others
- may present as being unaffected at a doctor consultation
- can perform well on initial cognitive screening tests, such as the Mini Mental State Examination .
A watch and review plan is sometimes suggested, or medication is offered for the most pressing health issue.
Family and friends can be advocates. They may express their concerns to the individual or perhaps consider talking to their doctor in person, or by telephone or letter. Together, the individual and family member or friend may visit the doctor and, if still concerned, ask for a referral to a specialist .
To assist the specialist, consider writing a diary of behaviours and actions of the person one week before the appointment, noting changes in behaviour, thinking and abilities that may be regarded as out of character for the person or troubling to the person or you. Reference days and times to indicate how often changes are present or not, for how long when present, and how frequently they change.
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Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
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Diagnosing Lewy Body Dementia: For Professionals
Lewy body dementia can be difficult to diagnose. Talking to both patients and caregivers helps doctors make a diagnosis. It is important to ask the patient and their care partners about any symptoms involving thinking, movement, sleep, behavior, or mood. Certain medications can worsen LBD symptoms be aware of all current medications and supplements the patient is taking.
Dementia with Lewy bodies is often hard to diagnose because its early symptoms may resemble those of Alzheimer’s disease or a psychiatric illness. As a result, it is often misdiagnosed or missed altogether. As additional symptoms appear, making an accurate diagnosis may become easier.
The good news is that doctors are increasingly able to diagnose LBD earlier and more accurately, as researchers identify which symptoms and biomarkers help distinguish it from similar disorders.
Visiting a family doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. If a persons primary doctor is not familiar with LBD, they may have patients seek second opinions from specialists, like a geriatric psychiatrist, neuropsychologist, or a geriatrician to help diagnose LBD. If a specialist cannot be found in your community, ask the neurology department at a nearby medical school for a referral. Neurologists generally have the expertise needed to diagnose LBD.
Difficult as it is, getting an accurate diagnosis of LBD early on is important so that a person:
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What Are The Symptoms Of Lewy Body Disease
The symptoms of Lewy body disease include:
- difficulty concentrating and paying attention
- visual hallucinations
- a mental state that switches rapidly between thinking clearly and being confused
- disturbed sleep, acting out dreams
- fainting spells, unsteadiness and falls
- problems with understanding, thinking, memory and judgement
If you have any of the symptoms above, see your doctor.
In contrast with Alzheimers disease, Lewy body disease doesnt cause short-term memory loss.
The 3 conditions that fall under the umbrella of Lewy body disease tend to overlap, but there are some differences in the mix of symptoms and the timing of when symptoms appear, that can help to distinguish the individual conditions.
Parkinsons disease usually involves a person developing symptoms of movement disorder first, including stiffness, slowness of movement and tremor. When dementia develops in a person with Parkinsons disease, it is usually 10-15 years after the other symptoms and is known as Parkinsons disease dementia.
Dementia with Lewy bodies has symptoms similar to Alzheimers disease including thinking problems and disorientation, but differs in that mental function fluctuates between good and poor in the early stages.
The problems with thinking and problems with movement usually appear within a year of each other in people with dementia with Lewy bodies. Usually the thinking problems come first. The movement problems include stiff muscles, shuffling when walking and stooping over .
Parkinson’s Disease Dementia And Dementia With Lewy Bodies
The key pathological hallmark found in brains of Parkinson’s disease and Parkinson’s disease dementia patients are abnormal microscopic deposits composed of -synuclein. This protein is found widely in the brain and its normal function is not yet well understood. The deposits are called “Lewy bodies”. Lewy bodies are also found in several other neurodegenerative brain disorders, including dementia with Lewy bodies . Evidence suggests that Parkinson’s disease and Parkinson’s disease dementia, and dementia with Lewy bodies, may be linked to the same underlying abnormalities in caused by the deposition of -synuclein.
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Treatment Of Behavior And Mood Problems In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Medications are appropriate if the behavior interferes with the person’s care or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of time is recommended.
The first step is to visit a doctor to see if a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers , and constipation can worsen behavioral problems and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-anxiety medicines can actually increase anxiety in people with LBD. Review your medications with your doctor to determine if any changes are needed.
Antidepressants can be used to treat depression and anxiety, which are common in LBD. Many of them are often well tolerated by people with LBD.
Diagnosis: Parkinson’s Dementia Or Dementia With Lewy Bodies
During assessment, a specialist may look at when the dementia symptoms first appeared before reaching a diagnosis of Parkinson’s dementia or dementia with Lewy bodies.
If there have been motor symptoms for at least one year before dementia symptoms occur, specialists will often give a diagnosis of Parkinson’s dementia.
If dementia symptoms occur before or at the same time as motor symptoms, specialists will usually give a diagnosis of dementia with Lewy bodies.
However, it should be noted that in some cases of dementia with Lewy bodies, no motor symptoms develop at all.
Theres no single test – diagnosis is made through several different assessments, usually starting with an appointment with your GP or Parkinson’s nurse.
Some people find it helps to go to the appointment with someone who knows them well, who can give the GP or Parkinson’s nurse information about changes they’ve noticed.
Your GP can discuss your symptoms with you and carry out a physical examination, including blood and urine tests, to rule out other potential causes of the symptoms .
Your GP may also review your medication, in case your symptoms are side effects.
If your GP thinks you have dementia, they can refer you to a specialist, such as a neurologist, psychiatrist or geriatrician.
You might be referred to a memory clinic or memory service. In some areas of the country, you can refer yourself to these services.
But if you feel you need to see the specialist again, you can ask to be referred back.
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