How Is Lewy Body Disease Treated
There is no cure for Lewy body disease, but a doctor may treat the symptoms with:
- Alzheimer’s disease medications to reduce hallucinations and behavioural problems
- Parkinson’s disease medications to improve rigid muscles and slow movement
- sleep medicines
Some medicines, such as antipsychotics, can make symptoms worse and may be dangerous. There are, however, other ways of dealing with symptoms, including:
- learning to manage a person’s behaviour
- learning how to calm the person down
- changing their environment to help them function
- creating daily routines
- using therapies, such as physiotherapy, occupational therapy and speech and language therapy
- providing cognitive stimulation
People with Lewy body disease usually need help at home and eventually care in a nursing home. The disease progresses differently in different people. After they develop symptoms, people live on average for another 6 to 12 years, although some live much longer.
Motor Features Of Parkinsonism
Parkinsonian motor signs often develop concurrently with or subsequent to these problems and are also diagnostically very useful. These motor signs are often symmetric, and bradykinesia and gait impairment are more common than rest tremor. However, the variance of the motor presentation is high. Some patients may present with a classic asymmetric pill-rolling tremor of PD while others may have no motor concerns yet will display clear extrapyramidal dysfunction on examination. In contrast to patients with PD, who have a sustained beneficial response to PD medications such as carbidopa/levodopa, patients with DLB often have a limited response to such medications. These patients nonetheless show reduced dopamine transporter activity on single-photon emission computed tomography or positron emission tomography imaging, when performed. Generalized myoclonus can also occur in some patients with DLB.
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.
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The Last Version Of Dlb Criteria Suggests The Use Of The General Term Lbd
The next subtype of LBD is the DLB phenotype. In contrast to PDD, this phenotype is a bit better bordered, its definition is more intelligible and the pathological finding is unique. This is characterized by diffuse alpha-synucleinopathy, accompanied in most cases by Alzheimers changes, especially senile plaques.
The birth of the DLB as a nosological entity was complicated and took many years of scientific debates, consensus meetings, publications, which ran continuously for almost the last decade of the 20th century. Finally, the existence of pathological co-habitation of Alzheimers pathological changes together with the diffuse appearance of LBs led the expert panel to the opinion, that the former attempts to name this disease were always the attempts to describe the findings typical for DLB.
The first clinical diagnostic criteria were published by McKeith et al. in 1996 the revised version came in 2005 and the last revision is from 2017,,. In the last revision, the nosological entity DLB has been classified rather as one of the phenotypes in the broader spectrum of LBD.
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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Lewy Body Dementia Research
Many avenues of research are being explored to improve our understanding of LBD. Some researchers are working to identify the specific differences in the brain between the two types of LBD. Others are looking at the disease’s underlying biology, genetics, and environmental risk factors. Still other scientists are trying to identify biomarkers , improve screening tests to aid diagnosis, and research new treatments.
Scientists hope that new knowledge about LBD will one day lead to more effective treatments and even ways to cure and prevent the disorder. Until then, researchers need volunteers with and without LBD for clinical studies.
NIH and other groups help people learn about clinical trials and studies and find research opportunities near them. Visit the following websites for details:
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.
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Managing Sleep Disorders In Lewy Body Dementia
Sleep problems may increase confusion and behavioral problems in people with LBD and add to a caregiver’s burden. A physician can order a sleep study to identify any underlying sleep disorders such as sleep apnea, restless leg syndrome, and REM sleep behavior disorder.
REM sleep behavior disorder, a common LBD symptom, involves acting out one’s dreams, leading to lost sleep and even injuries to individuals and their sleep partners. Clonazepam, a drug used to control seizures and relieve panic attacks, is often effective for the disorder at very low dosages. However, it can have side effects such as dizziness, unsteadiness, and problems with thinking. Melatonin, a naturally occurring hormone used to treat insomnia, may also offer some benefit when taken alone or with clonazepam.
Excessive daytime sleepiness is also common in LBD. If it is severe, a sleep specialist may prescribe a stimulant to help the person stay awake during the day.
Some people with LBD have difficulty falling asleep. If trouble sleeping at night persists, a physician may recommend a prescription medication. It is important to note that treating insomnia and other sleep problems in people with LBD has not been extensively studied, and that treatments may worsen daytime sleepiness and should be used with caution. Sleep problems can also be addressed by avoiding lengthy naps, increasing daytime exercise, and avoiding caffeine, alcohol, and chocolate late in the day.
How Can We Manage Hallucinations
It may not be necessary to treat all hallucinations of a person with DLB. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or his/her surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, most medications used to treat hallucinations may make movement symptoms worse.
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How To Help Someone Manage Lewy Body Dementia
When it comes to helping someone manage the symptoms of LBD, small things can often make a big difference.
Create a routine. It can help someone with LBD to have predictable routines, especially around meal times and sleep times.
Establish a nighttime ritual. Try to establish bedtime rituals that are calming and away from the noise of television, meal cleanup, and active family members. Limiting caffeine consumption and daytime napping, and encouraging exercise can help curb restlessness at night.
Modify tasks. Break tasks into easier steps and focus on success, not failure.
Walk together. Taking a walk with the patient with LBD is a win-win activity. Being outdoors and exercising is vital for the health and state of mind for both the patient and you.
Strengthen senses. Have a doctor evaluate each the patients five senses in order to identify and treat any abnormalities. Then ask about exercises to improve them.
Make lifestyle changes. To help minimize the risk of fall-related injuries, you can help stabilize blood pressure. Help your loved one stay well hydrated, exercise, take in adequate sodium , avoid prolonged bed rest, and stand up slowly.
Tips for managing behavioral changes
One of the major challenges of caring for a loved one with dementia can be coping with the troubling behavioral changes that often occur. As a caregiver, you cant change the person with dementia, but you can employ strategies to modify or better accommodate any problem behaviors.
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Can Imaging Tests Diagnose Lewy Body Dementia
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.
Diagnostic Criteria For Parkinson Disease Dementia
Consensus criteria for PDD were developed in 2007 . These criteria require cognitive impairments across multiple domains but emphasize that noncognitive features such as hallucinations are common. As described previously in the article, the clinical and neuropsychological features of DLB and PDD are similar. Indeed, it is the relative timing of dementia and parkinsonism that defines the clinical distinction between DLB and PDD. Controversy exists over how or whether to distinguish these syndromes.
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Mild Cognitive Impairment Preceding Dementia With Lewy Bodies
Patients with the clinical features of DLB but who remain independent for their instrumental and basic activities of daily living meet criteria for Lewy body spectrum MCI. The sensitivity and specificity for a diagnosis of Lewy bodyMCI are likely to be lower than for DLB, in part due to milder manifestations of the core criteria. Ancillary testing has yet to be validated in LB-MCI. For example, the prevalence of occipital hypometabolism appears to be reduced in LB-MCI compared with DLB. In addition, the sensitivity of the DAT scan may be reduced when extrapyramidal symptoms are mild. Like preclinical DLB, LB-MCI is a useful construct for therapeutic clinical trials and for biomarker studies.
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.
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Managing The Effects Of Dementia With Lewy Bodies
A person with dementia with Lewy bodies might:
- have recurring visual hallucinations see things that are not there
- experience disturbed sleep known as Rapid Eye Movement sleep disorder, in which people are restless and can experience intense dreams/nightmares
- experience sudden changes and fluctuations in alertness people may stare blankly into space for periods of time, seem drowsy and lethargic and spend a lot of time sleeping
- have slowed movement, difficulty walking, shuffling or appear rigid
- experience tremors usually in the hands whilst at rest
- have problems with balance and be prone to falls
- bladder and bowel problems
- difficulties with swallowing
Memory is often less affected than with other types of dementia but people may be at more risk of mood and behaviour changes such as apathy, anxiety, depression, delusions and paranoia. One type of delusion, known as Capgras syndrome, in which the person believes that a friend or relation has been replaced by an imposter can be particularly difficult for families. Other symptoms may include changes in blood pressure, body temperature and impaired sense of smell.
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A healthy diet can be a great memory loss remedy. Eat plenty of fruits and vegetables, as well as low-fat proteins such as nuts and seeds. Drinking plenty of water is also beneficial. The environment and personal experiences can affect the way your brain stores information, and this can lead to memory loss. There are many other causes of temporary memory loss, and it is important to get help as soon as possible. You should consult a medical professional to determine what the best treatment will be for your particular situation. Lewy Body Dementia and Parkinsons Disease
A healthy diet is another effective memory loss remedy. A healthy diet should include plenty of vegetables and fruits. A healthy diet is a key component in memory improvement. This is the best way to prevent memory loss. The best way to do this is to incorporate more fresh fruits and vegetables into your daily routine. If you cant eat fruits and vegetables, you should avoid them altogether. They are packed with antioxidants that can help your brain.
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Lewy Body Dementia: A Common Yet Underdiagnosed Dementia
While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.
Treatments For Parkinsons Disease Dementia And Dementia With Lewy Bodies
Treatments for DLB are similar to PDD and are aimed at symptom control. The motor symptoms of slowness, stiffness and walking difficulties can be treated with Levodopa. However, Levodopa can cause or exacerbate hallucinations, making it difficult to use it as a treatment for patients who have or are at risk of having hallucinations. Sometimes, clinicians will need to treat the hallucinations more aggressively in order for a patient to tolerate Levodopa given to help the motor symptoms. On the flipside, anti-psychotic medications to control hallucinations can worsen motor symptoms, so treating all the symptoms of LBD simultaneously can be a tricky balancing act.
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What Happens In Dlb
People with DLB may have trouble focusing, remembering things, staying awake during the day, or staying asleep at night. They may become more frustrated or confused because of the lack of sleep. They may also hallucinate and see people, objects, or animals that are not there.
Some people with DLB will need help with walking, while others may have hunched posture or trouble using their hands and feet because of stiff muscles. People with DLB may appear to be better and need less help on some days, only to become worse and more confused again and need more help the next day or in a few days. This is because their energy level and focus will vary.
DLB is a disease that changes with time. A person with DLB can live for many years with the disease. Research suggests that a person with DLB may live an average of 57 years with the disease, although this can vary from person to person.
Movement Problems And Lewy Body Dementia
Some people with LBD may not experience significant movement problems for several years. Others may have them early on. At first, movement symptoms, such as a change in handwriting, may be very mild and easily overlooked. Movement problems may include:
- Muscle rigidity or stiffness
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How Is Lewy Body Dementia Diagnosed
There are no medical tests that can diagnose Lewy body dementia with 100% accuracy. Specialists, including neurologists, geriatric psychiatrists, neuropsychologists and geriatricians, make the diagnosis of probable LBD based on the combined results of tests and patient symptoms.
Your healthcare provider will perform a thorough neurological and physical examination. You or your loved one will also complete mental status and neuropsychological tests. These tests check thinking abilities, including memory, word-finding, attention and visual-spatial skills. Your doctor will ask you and your family about your mental status and the history of your symptoms. Be sure to tell your healthcare provider of any physical, cognitive, memory, emotional, behavioral, movement, sleep or physical changes you or your loved one is having. Also, tell your healthcare provider about any of your current medications, supplements, vitamins, herbal products and frequently used over-the-counter products. These will be reviewed to see if they might be a cause of your or your loved ones symptoms.
Depending on your symptoms, your doctor may also test your blood. If your doctor needs more information, brain imaging studies may be performed.
If you have cognitive deficiency severe enough to impair daily life in the presence of any following clinical features, your doctor may suspect diagnosis of LBD: