Lewy Body Dementia

Lewy body dementia (LBD), the second most common form of dementia after Alzheimer’s disease, results in irreversible cognitive decline and movement problems similar to Parkinson’s disease.

Lewy bodies, the alpha-synuclein protein associated with Parkinson’s, develop in areas of the brain involved in thinking and motor control, causing Parkinson’s disease symptoms. These abnormal proteins are also found in the brains of Alzheimer’s patients, leading experts to believe there may be a Lewy body variant of Alzheimer’s, or that a person can have both. The similarities among these types of dementia make diagnosis difficult.

Lewy body dementia refers to both dementia with Lewy bodies and Parkinson’s disease dementia. Diagnosis depends on which symptoms occur first. In dementia with Lewy bodies, the patient starts with cognitive problems and later loses control of their movements.

Symptoms

Motor problems among patients with LBD include:

• Slow, rigid movements;
• Shuffling;
• Shaking
• Balance issues
• Repeated falls
• Fainting.

Patients may also have visual hallucinations, and alertness may fluctuate throughout the day. Delusions, daytime drowsiness and aggression may all occur in cases of Lewy body dementia; in addition to memory loss and confusion.

About half of all Lewy body dementia cases are associated with rapid eye movement (REM) sleep disorder, a condition where people act out their dreams. (Normally movement is suppressed during sleep.) This disorder can appear years before any symptoms of dementia or parkinsonism.

With Parkinson’s disease dementia, the patient starts out with motor problems or already has an existing Parkinson’s diagnosis, and dementia follows at least a year later.

The reason why Lewy bodies accumulate in the brain is unknown, but certain factors seem to increase chances of developing the disease.

• Advanced age (onset typically occurs between 50 and 85)
• Male gender
• Family history of LBD.

Treatment

This complex disease demands a comprehensive treatment plan. Every patient is unique in how their symptoms are expressed and how they react to certain medications. Cholinesterase inhibitors, used to treat Alzheimer’s disease, may be even more responsive to the cognitive symptoms of LBD. A Parkinson’s medication called levodopa may treat movement symptoms.

Whatever the case, individuals with Lewy body dementia should never take antipsychotics, as they are extremely sensitive to these drugs and taking them may worsen symptoms. Talk with your doctor about potential side affects before starting any medication, since Lewy body patients are more likely to have negative reactions to drugs used to treat individual symptoms (e.g. antidepressants, antispasmodics, tranquilizers and surgical anesthetics). Patients with REM sleep disorder may benefit from a sleep medication such as melatonin.

Due to the complications from taking medication, patients may consider other nondrug forms of therapy. Physical therapy-weight training, cardiovascular training, stretching and balancing exercises can help improve mood and some motor symptoms. In advanced stages, speech therapy can be beneficial for improving pronunciation and muscular strength in swallowing difficulties. Any kind of therapy promoting independence and reducing anxiety, such as occupational or music therapy, can help improve mood.

The complexity of this disease demands a strong patient support group. Working with family, friends and other people with LBD can provide the emotional support needed to improve patient outcomes and quality of life.