Description

Lewy body dementia is the second most common type of dementia after Alzheimer's disease. Protein deposits called Lewy bodies develop in nerve cells in the brain. The deposits of proteins affect brain regions involved in thinking, memory and movement. This condition is also known as dementia with Lewy bodies.

Lewy body dementia causes a decrease in mental abilities that gradually gets worse over time. People with dementia with Lewy bodies may see things that are not there. This is known as visual hallucinations. They may also have changes in alertness and attention.

People with Lewy body dementia may experience symptoms of Parkinson's disease. These symptoms may include muscle stiffness, slow movement, difficulty walking and tremors.

Symptoms

Lewy body dementia symptoms may include:

  • The visual hallucinations. Seeing things that do not exist, known as hallucinations, may be one of the first symptoms of Lewy body dementia. This symptom often occurs on a regular basis. People with dementia with Lewy bodies can see the shapes, animals or people that do not exist. Hallucinations that involve the sounds, smells or touch are possible.
  • Movement disorders. The signs of Parkinson's disease, known as parkinson's disease signs, can occur. These symptoms include slowness of movement, muscular rigidity, tremor, or a shuffling walk. This may cause the person to fall down.
  • The poor regulation of the functions of the body. The part of the nervous system that controls the automatic functions is called the autonomic nervous system. Lewy body dementia can affect how well the autonomic nervous system controls blood pressure, heart rate, sweating, and digestion. This can result in a sharp drop in blood pressure when standing up, dizziness, falls, loss of control of bladder and bowel issues such as constipation.
  • The cognitive problems. People with Lewy body dementia may have problems with reasoning similar to those of Alzheimer's disease. They may include confusion, lack of attention, visual-spatial problems and memory loss.
  • Problems with sleep. People with dementia with Lewy bodies can have rapid eye movement (REM) sleep behavior disorder. This disorder makes people physically act out their dreams while asleep. Persons with a disorder of REM sleep behaviour you can punch, kick, scream, or cry out while you sleep.
  • By varying the attention. The episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.
  • Depression. People with dementia with Lewy bodies may develop depression.
  • Apathy. The loss of motivation that can occur.

Causes

Lewy body dementia is characterized by the accumulation of proteins in the mass, known as Lewy bodies. This protein is also associated with Parkinson's disease. People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer's disease.

Risk factors

Some factors that seem to increase the risk of developing Lewy body dementia, including:

  • Age. People over the age of 60 years are at the greatest risk.
  • Sex. Lewy body dementia affects more men than women.
  • The history of the family. Those that have a family member with Lewy body dementia or Parkinson's disease are at greater risk.

Complications

Lewy body dementia is progressive. This means that gradually gets worse over time. As symptoms get worse, Lewy body dementia can lead to:

  • Severe dementia.
  • The aggressive behavior.
  • Depression.
  • Increased risk of falls and injuries.
  • Worsening of parkinsonian symptoms, such as tremors.
  • The death, on average, about 7 to 8 years after the onset of symptoms.

Diagnosis

People who are diagnosed with Lewy body dementia have a gradual decrease in the ability to think. Also have at least two of the following:

  • By varying the state of alert, and the thought of the function.
  • Repeated visual hallucinations.
  • Parkinsonian symptoms.
  • REM sleep behavior disorder, in which people act out their dreams during sleep.

Other symptoms supporting a diagnosis of dementia with Lewy bodies. This includes problems with the autonomic nervous system. When this happens, the body is not able to regulate the blood pressure, heart rate, body temperature, and sweating.

The sensitivity to the drugs that treat psychosis also supports the diagnosis. This is particularly true for drugs such as haloperidol (Haldol). Antipsychotic medications are not used by the people with dementia with Lewy bodies as they can worsen the symptoms.

There is No single test can diagnose Lewy body dementia. The diagnosis is based on symptoms and by ruling out other conditions. Tests may include:

Neurological and physical examination

Your doctor can check to see if there are signs of Parkinson's disease, stroke, tumors or other medical conditions that can affect the brain and physical function. A neurological examination tests:

  • Reflections.
  • Force.
  • Walk.
  • The muscle tone.
  • Movements of the eyes.
  • Balance.
  • The sense of touch.

Evaluation of the mental abilities

A short form of this test, which assesses memory and thinking skills, you can make it in less than 10 minutes. The test does not usually distinguish between Lewy body dementia and Alzheimer's disease. But the test can determine if you have a cognitive impairment. Most tests take several hours to help to identify Lewy body dementia.

Blood tests

These can rule out physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.

The brain scans

Your doctor may order an mri or a ct scan to identify a stroke or bleeding and to rule out a tumor. The dementia is diagnosed based on the clinical history and physical examination. But certain features on imaging studies may suggest different types of dementia, such as Alzheimer's or Lewy body dementia.

If the diagnosis is unclear, or symptoms are not typical, you may need other imaging tests. These imaging tests can support a diagnosis of dementia with Lewy bodies:

  • Fdg PET scans of the brain, which assesses the function of the brain.
  • Single-photon emission computed tomography (SPECT) or PET. These tests may show reduced dopamine transporter uptake in the brain. This can help to diagnose Lewy body dementia.

Evaluation of sleep

You may need an assessment of sleep called sleep study to check for REM sleep behavior disorder. You may also need an autonomic function test to detect signs of heart rate and blood pressure instability.

Examination of the heart

In some countries, health professionals may also order an examination of the heart called myocardial scintigraphy. This checks the blood flow to your heart to the signs of Lewy body dementia. However, the test is not used in the united States.

Emerging biomarkers

The research is in progress in other indicators of the Lewy body dementia. These biomarkers, eventually, could allow the early diagnosis of dementia with Lewy bodies before the disease develops.

Treatment

There is No cure for dementia with Lewy bodies, but many of the symptoms may improve with specific treatment.

Drugs

  • Cholinesterase inhibitors.These of Alzheimer's disease medications work by increasing the levels of chemical messengers in the brain, known as neurotransmitters. These chemical messengers are believed to be important for memory, thinking, and judgment. They include rivastigmine (Exelon), donepezil (Aricept, Adlarity) and galantamine (Razadyne ER). Medications can help improve alertness and thinking. It can also reduce hallucinations and other symptoms of behavior. Possible side effects include upset stomach, muscle cramps, and urinating more often. You can also increase the risk of certain cardiac arrhythmias. In some people with moderate or severe dementia, an N-methyl-d-aspartate (NMDA) receptor antagonist called memantine (Namenda), you can add a cholinesterase inhibitor.
  • Parkinson's disease medications. Medications such as carbidopa-levodopa (Sinemet, Duopa, others) may help to reduce muscle stiffness and slowness of movement. However, these medications may also increase the confusion, hallucinations, and delusions.
  • Medications to treat other symptoms. Your doctor may prescribe medications to treat other symptoms, such as trouble sleeping, or problems with movement.

Cholinesterase inhibitors. These of Alzheimer's disease medications work by increasing the levels of chemical messengers in the brain, known as neurotransmitters. These chemical messengers are believed to be important for memory, thinking, and judgment. They include rivastigmine (Exelon), donepezil (Aricept, Adlarity) and galantamine (Razadyne ER). Medications can help improve alertness and thinking. It can also reduce hallucinations and other symptoms of behavior.

Possible side effects include upset stomach, muscle cramps, and urinating more often. You can also increase the risk of certain cardiac arrhythmias.

In some people with moderate or severe dementia, an N-methyl-d-aspartate (NMDA) receptor antagonist called memantine (Namenda), you can add a cholinesterase inhibitor.

Certain drugs may worsen the memory. Do not take sleep medications that contain diphenhydramine (Advil PM, Aleve PM). Also do not take medicines used to treat urinary urgency, such as oxybutynin (Ditropan XL. Gelnique, Oxytrol).

Limit of sedatives and sleep medications. Talk with a health professional about whether any medicines you take may make your memory worse.

Antipsychotic medications can cause severe confusion, severe parkinsonism, sedation, and sometimes death. Very rarely, some second-generation antipsychotics, such as quetiapine (Seroquel) or clozapine (Clozaril, Versacloz) can be prescribed for a short time at a low dose. But they are offered only if the benefits outweigh the risks.

Therapies

Antipsychotic drugs may worsen the symptoms of dementia of Lewy body. It may be useful to first try other approaches, such as:

  • To tolerate the behavior. Some people with dementia with Lewy bodies are not distressed by hallucinations. If this is true, the side effects of the medicine may be worse than the hallucinations themselves.
  • The modification of the environment. Reduce the clutter and noise can make it easier for someone with dementia to function. The caretakers of the answers sometimes worsen the behavior. Avoid the correction and test of a person with dementia. We offer peace of mind and the validation of their concerns.
  • Creating daily routines and tasks of simple maintenance. Divide the tasks into small steps and focus on the successes, not failures. The structure and routine during the day can be less confusing.

Lifestyle and home remedies

Symptoms and progression are different for each person with Lewy body dementia. Caregivers and care partners may be necessary to adapt the following advice for individual situations:

  • Talk about a clear and simple way. Maintain eye contact and speak slowly, with simple sentences, and do not hurry with the answer. The present only one idea or one instruction at a time. The use of gestures and signals, such as pointing to objects.
  • Encourage exercise. The benefits of exercise, which include improvements in physical function, behavior and depression. Some research shows that exercise could reduce the cognitive decline in people with dementia.
  • To provide the stimulation of the mind. Participation in games, crossword puzzles and other activities that involve thinking skills could help to delay mental decline in people with dementia. Encourage artistic and creative activities, such as painting, singing, or music.
  • Create opportunities for social activity. Talk with friends. Participate in the religious services.
  • Establish bedtime rituals. Behavior problems can be made worse by the night. Create a soothing bedtime ritual without the distraction of the tv, the food, the cleanliness and active members of the family. Leave the lights of the night to avoid the disorientation.

Limit the consumption of caffeine during the day. Discourage the day of the nap and the range of activities on offer for the exercises during the day. This can help prevent the restlessness of the night.

Alternative medicine

The frustration and anxiety can worsen the symptoms of dementia. To promote relaxation, consider:

  • Music therapy, which involves listening to relaxing music.
  • Pet therapy, which involves the use of animals to enhance the moods and behaviors in people with dementia.
  • Aromatherapy, which uses fragrant plant oils.
  • Massage therapy.

Coping and support

People with dementia with Lewy bodies often have a mixture of emotions. The person may feel confused, frustrated, angry, or afraid. It may not be true about the future, and you can feel the pain and depression. Offer support by listening. Provide the assurance that the person can still enjoy life. Be positive and do your best to help the person to preserve the dignity and self-respect.

If you are a caregiver or care partner for someone with Lewy body dementia, look with attention to the person. Make sure that the person does not fall out, lose consciousness or have a bad reaction to the drugs. Provide support during times of confusion, delusions, or hallucinations.

Take care of yourself

Caring for a person with dementia with Lewy bodies can be exhausting physically and emotionally. You can have the anger, the guilt, the frustration, discouragement, worry, sadness, or social isolation. Help prevent caregiver burnout by:

  • Asking friends or other family members for help when you need it. Consider in-home health services for the care of the person with Lewy body dementia.
  • Exercise regularly and eat a healthy diet.
  • Learn about the disease. Ask questions to doctors, social workers and other professionals in the care team.
  • Join a support group.

Many people with Lewy body dementia and their families may benefit from counseling or local support groups. Contact your local health agencies or aging. Local agencies can help you connect with support groups, health professionals, resources, referrals, home care agencies, supervised living facilities, a telephone help line, and educational seminars.

Preparing for your appointment

You can talk about your symptoms with a health care professional. This person can refer you to a medical doctor trained in dementia. This is usually a doctor trained in brain and nervous system conditions, call a neurologist or a physician trained in mental health conditions, called a psychiatrist.

Ask a friend or family member to come to the appointment, if possible. This person can help you remember the information they give you, and give your doctor information about you. Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms and when they began.
  • All medications, vitamins or supplements that you take, including over-dose.
  • Questions to ask.

What to expect from your doctor

You, your spouse, partner or close friend will probably be asked a series of questions about:

  • The changes in memory, personality and behavior.
  • The visual hallucinations.
  • His a history of stroke, depression, alcohol use disorder, head trauma or other neurological disorders.
Symptoms and treatment of dementia with Lewy bodies