Clinical And Neuropathological Differences Between Parkinson’s Disease Parkinson’s Disease Dementia And Dementia With Lewy Bodies Current Issues And Future Directions
Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle-upon-Tyne, UK
First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
Biomedical Research Foundation of the Academy of Athens, Athens, Greece
Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle-upon-Tyne, UK
First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
Biomedical Research Foundation of the Academy of Athens, Athens, Greece
Comparison Of Motor Symptoms
On the Hoehn and Yahr scale as well as on UPDRS III and IV , the PDD group had significantly higher scores than the DLB group, but there was no significant difference in predominant motor subtype between both groups. The tremor severity was higher in the PDD group, but only regarding the tremor at rest, which was marginally significant . Compared to DLB patients, PDD patients also demonstrated a significantly higher score on hand and feet bradykinesia as well as a tendency towards increased rigidity.
Deficits In Attention/executive Functions
In the domain of attention/executive functions, DLB patients performed significantly worse on digit span backward and MCST than PDD patients. In 2014, Yoon et al. also found that the attention/executive domain is more affected in DLB compared to PD even in the mild cognitive impairment stage. A recent neuroimaging study showed that numbers of categories achieved and perseverative errors in the Wisconsin Card Sorting Test should be differentially estimated, because they reflect the function of different brain regions in patients with early dementia , i.e. categories achieved mainly reflect the function of the precentral segments, whereas perseverative error scores correlate with metabolic activity in the right thalamus.
Read Also: Deep Brain Stimulation For Parkinson’s Disease Success Rate
Dementia With Lewy Bodies Without Parkinsonism
I agree with the proposal of new criteria for the diagnosis and management of dementia with Lewy bodies . Previous criteria did not adequately differentiate DLB from Parkinson disease with dementia as outlined in the articles accompanying editorial.
Lewy body disease includes PD and DLB, thus there should be DLB without parkinsonism as well as PDD. The new criteria outlined four core clinical features: fluctuating cognition with pronounced variations in attention and alertness detailed, recurrent visual hallucinations REM sleep behavior disorder, which may precede cognitive decline and one or more spontaneous cardinal features of parkinsonism including bradykinesia, rest tremor, or rigidity. According to this criteria, a patient who has the first three clinical features but does not have parkinsonism may be diagnosed as DLB.
Braak et al. proposed that brainstem synucleinopathy progresses rostrally to affect the substantia nigra, which may cause parkinsonism. . However, these described patterns of synucleinopathy are not often observed in DLB, especially when synucleinopathy occurs in the absence of parkinsonism. Braak et al.s hypothesis would indicate that visual hallucinations are a result of occipital dysfunction. Meanwhile, attention and alertness are due to frontal dysfunction, which does not necessarily follow Braaks hypothesis. In addition, DLB patients with predominantly frontal dysfunction may not have parkinsonism.
What Is Vascular Dementia
Vascular dementia is the second most common type of dementia in the UK after Alzheimer’s disease. It occurs when the brain is damaged due to a lack of blood flow.
Sometimes people have both vascular dementia and Alzheimer’s, 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.
Read Also: Symptoms Of Parkinson Disease Webmd
Different Types Of Dementia
The term âdementiaâ is really an umbrella term for several diseases, including:
Now letâs dive deeper in to these two forms of dementia: Alzheimerâs Disease and Lewy Body Dementia.
Whats The Difference Between Lewy Body Dementia Parkinsons Disease And Alzheimers Disease
Lewy body dementia is an umbrella term for two related clinical diagnoses: dementia with Lewy bodies and Parkinsons disease dementia. These disorders share the same underlying changes in the brain and very similar symptoms, but the symptoms appear in a different order depending on where the Lewy bodies first form.
Dementia with Lewy bodies is a type of dementia that causes problems with memory and thinking abilities that are severe enough to interfere with everyday activities. It specifically affects a persons ability to plan and solve problems, called executive function, and their ability to understand visual information. Dementia always appears first in DLB. The motor symptoms of Parkinsons such as tremor, slowness, stiffness and walking/balance/gait problems usually become more evident as the disease progresses. Visual hallucinations, REM sleep behavior disorder, fluctuating levels of alertness and attention, mood changes and autonomic dysfunction are also characteristic of DLB.
Finally, Alzheimers is characterized by different abnormal clumps called amyloid plaques, and jumbled fiber bundles called tau tangles. These microscopic structural changes in the brain were discovered by Dr. Alois Alzheimer in 1906. These plaques and tangles, together with loss of connections between nerve cells, contribute to loss of coherence and memory, as well as a progressive impairment in conducting normal activities of daily living.
Read Also: How Can You Test For Parkinson’s Disease
The Link To Parkinsons Disease
Most people with Parkinsons disease have Lewy bodies in their brains. Its these clusters that cause some or all of the motor symptoms of Parkinsons disease, as well as memory or cognitive problems, visual hallucinations, and problems with alertness.
We rarely know if a living patient has Lewy bodies with certainty, however. Its not until an autopsy that they can be seen, says Liana Rosenthal, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine. If we see Lewy bodies in someones brain during an autopsy, thats considered a pathologic certainty of Parkinsons disease, she says.
As with Parkinsons, Lewy body dementia is associated with a depletion of certain neurotransmitters in the brain. These are:
- Dopamine: This neurotransmitter helps transmit signals that control muscle movement. When the accumulation of Lewy bodies blocks dopamines production and transmission, the result is the hallmark movement issues of Parkinsons disease.
- Acetylcholine: This neurotransmitter does its work in the parts of the brain responsible for memory, thinking and processing. When Lewy bodies build up in these areas, they interfere with acetylcholine, causing symptoms of dementia.
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.
Also Check: Treatment For Parkinson’s Disease Usually Includes
What Causes Lewy Body Dementia
The causes of LBD are not yet well understood, but research is ongoing in this area. There are probably multiple factors involved, including genetic and environmental risk factors that combine with natural aging processes to make someone susceptible to LBD.
For more information, visit www.lbda.org.
Modified with permission from the Lewy Body Dementia Association
To learn more about motor symptoms related to Parkinsons, visit here.
To learn more about non-motor symptoms related to Parkinsons, visit here.
What Is Lewy Body Dementia Causes Symptoms And Treatments
On this page:
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.
Read Also: Can Medication Cause Parkinson’s
Two Of The Following Are Present :
- Fluctuating cognition: Mental problems varying during the day, especially attention and alertness.
- Visual hallucinations: Detailed and well-formed visions, which occur and recur.
- RBD: Physically acting out dreams while asleep.
A DLB diagnosis is even more likely if the individual also experiences any of the following: repeated falls, fainting, brief loss of consciousness, delusions, apathy, anxiety, problems with temperature and blood pressure regulation, urinary incontinence, and chronic constipation, loss of smell, or sensitivity to neuroleptic medications that are given to control hallucinations and other psychiatric symptoms.
Finally, the timing of symptoms is a reliable clue: if cognitive symptoms appear before or within a year of motor symptoms, DLB is more likely the cause than Parkinsonâs disease. Signs of stroke or vascular dementia usually negate the likelihood of DLB.
Testing is usually done to rule out other possible causes of dementia, motor, or behavioral symptoms. Brain imaging can detect brain shrinkage and help rule out stroke, fluid on the brain , or subdural hematoma. Blood and other tests might show vitamin B12 deficiency, thyroid problems, syphilis, HIV, or vascular disease. Depression is also a common cause of dementia-like symptoms. Additional tests can include an electroencephalogram or spinal tap .
How Is Lbd Different From Parkinsons Or Alzheimers
These diseases are similar in a lot of ways. But there are some key differences in the symptoms that affect people with LBD and when those symptoms happen.
LBD may not cause short-term memory loss like Alzheimerâs. People with both conditions have trouble with thinking, alertness, and paying attention. But in LBD, those problems come and go. The disease can also cause hallucinations, often in the first few years someone has LBD. People with Alzheimerâs usually donât have hallucinations until the later stages.
People with LBD also often act out their dreams and make violent movements when theyâre asleep. Itâs called REM sleep behavior disorder. Sometimes, itâs the first sign that someone has LBD.
LBD and Parkinsonâs disease both cause movement problems, like stiff muscles and tremors. But most people with Parkinsonâs donât have problems with their thinking and memory until the very later stages of their disease. Sometimes, they donât have it at all. In the type of LBD known as Parkinsonâs disease with dementia, these problems begin much sooner.
People with LBD also need different drugs for their condition than the ones that treat Parkinsonâs or Alzheimerâs.
Don’t Miss: Que Es El Mal De Parkinson
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.
To learn more about putting these strategies into action, see Preventing Alzheimers Disease.
Difference Between Parkinsons Disease Dementia And Dementia With Lewy Bodies
Technically, the difference between these two conditions lies in how quickly the cognitive difficulties and hallucinations develop in relation to the movement issues. In DLB, the cognitive difficulties and hallucinations develop much sooner in the disease course than in PDD, sometimes even prior to the movement difficulties. Because of the similarities between PD, PDD, and DLB, current thinking in the medical community is that they should be viewed as related diseases which fall along a continuum of Lewy body disorders.
Don’t Miss: What Are The Early Signs And Symptoms Of Parkinson’s Disease
Apda In Your Community
APDAParkinson’s Disease SymptomsLewy Bodies, Dementia, and Parkinsons What Does it all Mean?
Here are two common scenarios that may sound familiar:
Scenario 1A patient develops a series of neurologic symptoms, is evaluated by a neurologist and is told that she has Parkinsons disease . She then visits another neurologist for a second opinion and is told she has Lewy Body Dementia .
Scenario 2A patient has his first visit with his neurologist and is told that he has PD, at a subsequent visit the diagnosis is changed to Parkinsons disease dementia , and at a follow up visit the diagnosis is changed yet again to Dementia with Lewy Bodies .
Both of these situations understandably cause great uncertainty and frustration.
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.
Recommended Reading: Fluid Retention And Parkinson’s
Memory And Thinking Problems
You may experience forgetfulness, slowed thinking and difficulty concentrating. You might find it harder to follow conversations, and remember some words and names. This can make communication difficult.
You may also find it increasingly difficult to make decisions, plan activities and solve problems. This can make everyday activities harder.
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.
Recommended Reading: Types Of Parkinson’s Disease
What Are The Types Of Lewy Body Dementia
There are two types of LBD: dementia with Lewy bodies and Parkinson’s disease dementia.
Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive and movement symptoms start.
Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer’s disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.
Parkinson’s disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson’s disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.
Alzheimers Risk Factors And Alzheimers Disease Treatments
The greatest risk factor for developing Alzheimerâs is age, but genetics and family history also play a role. After age 65, the risk of Alzheimerâs doubles every five years. 32% of people age 85 and older have Alzheimerâs Disease.
Unfortunately, there is no medication or therapy available to prevent, treat or slow the progression of Alzheimerâs. But, there are FDA approved treatments that can address symptoms, that come in two primary forms:
- Cholinesterase Inhibitors to prevent the breakdown of acetylcholine which is important for memory.
- Glutamate Modulators: regulates glutamate activity which is important for information storage and retrieval.
Also Check: What Does Parkinson’s Disease Cause