Wednesday, September 21, 2022

Lewy Body Dementia And Parkinsonism

How Is Lbd Different From Parkinsons Or Alzheimers

Parkinson’s Disease – Lewy Body Disorders: Carol Persad

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.

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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.

The Difference Between Parkinsons Disease And Lewy Body Dementia

One of the most confusing concepts to explain in the clinic is the difference between Parkinsons Disease, Parkinsons Disease Dementia and Lewy Body Dementia. Ultimately people with Parkinsons can look very similar with motor and non-motor problems. This is particularly tricky when PwP first present but the easiest way to consider Lewy Body Dementia is like having a very aggressive progression of Parkinsons where patients are dementing in the first year of their condition whereas this process is much slower when patients develop Parkinsons Disease Dementia. Indeed, clinically Lewy Body Dementia patients look like they have a cross between Parkinsons and Alzheimers, which is actually close to what is seen down the microscope when researchers study the brain. Understanding the differences between Parkinsons Disease and Lewy Body Dementia is not only difficult for patients and their families but has led some professional groups to try and lump all of these patients together under one umbrella, which probably does little to help individual families appreciate what the future holds.

Hopefully this video will help you to gain a more complete understanding of the differences between Parkinsons Disease, Parkinsons Disease Dementia and Lewy Body Dementia.

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Living With Parkinson Disease

These measures can help you live well with Parkinson disease:

  • An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
  • High protein meals can benefit your brain chemistry
  • Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
  • If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.

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Can Imaging Tests Diagnose Lewy Body Dementia

Lewy Body Dementia Symptoms [Infographic]

Imaging tests, such as computed tomography or magnetic resonance imaging , are done to rule out other causes of dementia such as brain tumors, brain bleeds, stroke, hydrocephalus or other structural causes. Imaging studies for Lewy body dementia are usually normal. The only way to make an absolute diagnosis of LBD is by examining the brain at autopsy.

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It Can Be Linked With Other Symptoms People Think Are Unrelated

Nobodys going to say, I have constipation and cognitive impairment, maybe theres a connection. But in Lewy body dementia, maybe there is, Taylor says.

People with Lewy body dementia can also have vivid hallucinations, REM sleep behavior disorders, and changes in the autonomic nervous system.

People with even mild cognitive impairment may see animals, people, insects, or other objects that arent there. This is a warning sign that its likely not Alzheimers, if its happening early, Taylor says.

Hallucinations can lead to unsafe behavior, Yanis says. For example, people might sit outside in the heat all day because of the strangers in the living room. And hallucinations can be mistaken for psychosis and delay diagnosis.

REM sleep behavior disorder could start years or decades before Lewy body dementia, or could kick in around the same time that cognitive impairment begins. Its an easy condition for a bed partner to suspect, Taylor says, because people with the disorder act out their dreams, so they might yell, kick, or thrash in their sleep.

Problems with the autonomic nervous system mean people could have trouble properly regulating their blood pressure, digestion, or body temperature. They might fall frequently, drool, become incontinent, lose their sense of smell, or see changes in their color vision, Taylor says.

What Are Pd Dementia Safety Concerns

Safety issues should be considered and monitored from the time of diagnosis. As PDD progresses, ensure that your loved one is not left alone.

  • Evaluate driving privileges before safety is a concern. Your doctor can make a driving evaluation referral.
  • Work out legal and financial issues and safeguard finances. People with dementia are at greater risk of falling victim to scams and fraud.
  • Minimize prescription risks. Confirm with the doctor the medication names and doses of the person with PD. If the person is in dementias early stages and capable, fill up their weekly pill box together and monitor use.
  • Medical alert systems can be critical in case your loved one falls or wanders outside of the home. Many types of systems are available, from bracelets and pendants to smart watches with fall detection and one-button connections to 911.
  • Evaluate gun safety. If your loved one owns a firearm or has one in the home, consider speaking with their doctor about the subject and taking appropriate safety precautions.

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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.

  • Get regular exercise to stimulate your brains ability to maintain old connections, make new ones, and slow deterioration of cognitive abilities.
  • Social engagement, connecting face-to-face with others, can help improve your cognitive function will be.
  • Eating a brain-healthy diet can help reduce inflammation and promote better communication between brain cells.
  • Mental stimulation, learning new things, and challenging your brain can help strengthen your cognitive skills.
  • Getting quality sleep can flush out brain toxins and avoid the build-up of damaging plaques.
  • Managing stress can help slow shrinking to a key memory area of the brain and protect nerve cell growth.
  • To learn more about putting these strategies into action, see Preventing Alzheimers Disease.

    Wait So What Is Parkinsonism

    Living With Lewy Body Dementia and Parkinsonism | Patient Perspectives | Being Patient Alzheimer’s

    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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    Life Expectancy For Lewy Body Dementia

    francis1505156449 over a year ago

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    over a year ago

    Hello there,

    First of all I am very sorry to hear that your mother isdiagnosed with such a difficult condition. Lewy body dementia is very difficultto treat and people with Lewy body dementia usually have severe reactions toantipsychotic medications which are usually very helpful in treating symptomssuch as delusions and hallucinations.

    At the moment there is no cure forthis condition and average life expectancy, according to fewstudies, for a person with Lewy body dementia after the first symptoms appearis 7 years. But this doesnt have to mean anything because every person isdifferent and this also depends on some other factors such as age, the severityof symptoms, and coexisting medical conditions.

    Since your mother is fullof energy I believe that she will beat the statistics.

    over a year ago

    In reply to danell34630 on 2012-01-17 click to read

    over a year ago

    In reply to anonymous on 2015-06-16 click to read

    Loading

    Outlook For Dementia With Lewy Bodies

    How quickly dementia with Lewy bodies gets worse varies from person to person.

    Home-based help will usually be needed, and some people will eventually need care in a nursing home.

    The average survival time after diagnosis is similar to that of Alzheimer’s disease around 6 to 12 years. But this is highly variable and some people live much longer than this.

    If you or a loved one has been diagnosed with dementia, remember that you’re not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.

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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 Lewy Body Dementia And Why Is It So Hard To Diagnose

    Lewy Bodies in Parkinson

    TW: This article contains mention of suicide. Please proceed thoughtfully.

    Today marks the eighth anniversary of Robin Williams’s death. The legendary comedian and actor committed suicide in 2014 at age 63. Williams suffered from depression and was misdiagnosed with Parkinson’s disease, which played a role in the “frustration” and discomfort Williams experienced in life, according to his son Zak Williams who spoke last year on The Genius Life podcast about the misdiagnosis. It was later discovered after the comedian’s death that he actually had Lewy body dementia.

    The brain disease impacted Williams’ thinking, memory, and movement control which got in the way of both his career and family life, his son said on the podcast. “There was a focus issue that frustrated him, there were issues associated with how he felt and also from a neurological perspective he didn’t feel great,” he says.

    Dad, on the eighth anniversary of your passing, I’m remembering how incredibly kind and joyful you were. I deeply miss you you wonderful, hairy man and will be celebrating your life today. Love you so so much!

    â Zak Williams

    “What he was going through didn’t match one to one many Parkinson’s patients experience,” Zak said. “So, I think that was hard for him.”

    So why was Williams misdiagnosed? According to experts, there are many similarities between Parkinson’s disease and Lewy body dementia. Keep reading to learn more about Lewy body dementia, including causes, symptoms, and treatment.

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    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.

    Are There Medicines To Treat Dlb

    Though there is no cure for DLB yet, there are medications that help manage the symptoms. These medications are called cholinesterase inhibitors, and they can help if a person with DLB is having memory problems. Some examples of these medicines are donepezil, rivastigmine and galantamine. If a person with DLB has movement symptoms they may be treated with medications used for Parkinsons disease, such as levodopa. Sleep problems may be managed by sleep medications including melatonin.

    Because people with DLB are usually very sensitive to medications, any new medication, even one that is not being used for the brain, needs to be reviewed with the persons provider to avoid potential contraindication.

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    What Complications Are Associated With Medications Used To Treat Lewy Body Dementia

    Up to 50% of people living with Lewy body dementia can have severe side effects when treated with certain antipsychotic medications. These are known as the typical or traditional antipsychotics and include such drugs as thoridazine, haloperidol, chlorpromazine and perphenazine. This class of older, first-generation antipsychotics can cause sedation and make cognitive symptoms and movement problems worse. A life-threatening reaction to an antipsychotic medication, called neuroleptic malignant syndrome, is possible. Symptoms include rigid muscles, changing blood pressure, high fever, confusion and fast heart rate. Contact your healthcare provider immediately if you or your loved are taking an antipsychotic and develop these symptoms.

    Visual hallucinations and behavioral changes may be treated with the newer, atypical antipsychotic medications pimavanserin , quetiapine or clozapine . However, because all antipsychotic medications both older, typical medications and newer atypical medications can increase the risk of death in elderly patients with dementia, you and your healthcare provider should carefully discuss the risks and benefits and using these medications.

    Other medications, like antidepressants or sedative antihistamines, may increase confusion in people with LBD.

    Can Lewy Body Dementia Be Treated Or Cured

    The differentiation between Lewy body and Parkinson’s disease dementia

    Unfortunately, there is no cure for Lewy body dementia, so treatment focuses on managing symptoms, says the NIA. Behavioral and mood changes worsen as thinking abilities decline, making depression, apathy, agitation, paranoia, and delusions common. Certain Alzheimer’s disease medications and Parkinson’s disease medications may be used to address symptoms. Non-drug approaches may also be helpful. Certain lifestyle changes, like modifying your environment and creating daily routines, may also aid in symptom relief, per the Mayo Clinic. It is recommended to work with both a neurologist who specializes in dementia, in addition to a counselor to offer emotional support.

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    Epidemiology And Natural History Of Dlb And Pdd

    Approximately 12% of those aged above 65 years are diagnosed with DLB worldwide , affecting approximately 5% of all dementia cases in those over the age of 75 . Its incidence is 0.71.4 new cases/100,000 person-years or 3.5/100,000 person-years . For PDD, the cumulative prevalence is of 75% of PD patients surviving more than 10 years , 83% after 20 years , and up to 95% by age 90 years , with an overall prevalence of 31.1% and incidence rates from 0.43 to 1.13/100,000 person-years , indicating that, annually, approximately 10% of a PD population will develop dementia . The data concerning age at disease or dementia onset are highly variable. Whereas in the Olmsted County study DLB patients were younger at symptom onset than those with PDD and had more hallucinations and cognitive fluctuations, others have reported younger age at disease onset in PDD , or no essential differences between disorders .

    Treatment Of Hallucinations Delusions And Agitation

    Visual hallucinations, delusions, and other productive-psychotic symptoms may occur early on in the disease course in dementia with Lewy bodies. In Parkinsons disease, these often develop only during the course of the disease, and in a scenario where new hallucinations or psychoses occur for the first time after a change in medication, the most recent change in medication should be reversed . If this does not yield the desired success or if hallucinations occur without prior change of medication, the medication for Parkinsons disease should be changed according to the treatment algorithm provided in the guidelines .

    Algorithm for the treatment of psychosis PDD, Parkinsons disease dementia DLB, dementia with Lewy bodies

    If this does not improve the productive-psychotic symptoms to a satisfactory degree, the use of antipsychotics may be considered. This is particularly the case when a reduction in the Parkinson medication is followed by a substantial deterioration in motor functioning, so that a minimum dose of levodopa is a definite requirement.

    It is in particular the productive-psychotic symptoms of dementia with Lewy bodies and Parkinsons disease dementia that place a heavy burden on relatives and carers they are also responsible for a multitude of admissions to residential care homes, so that medication treatment is absolutely essential.

    In acute situations, patients may be given a short course of clomethiazole and lorazepam .

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