What Are The Causes Of Lewy Body Dementia
The precise cause of LBD is unknown, but scientists are learning more about its biology and genetics. For example, we know that an accumulation of Lewy bodies is associated with a loss of certain neurons in the brain that produce two important chemicals that act as messengers between brain cells . One of these messengers, acetylcholine, is important for memory and learning. The other, dopamine, plays an important role in behavior, cognition, movement, motivation, sleep, and mood.
Scientists are also learning about risk factors for LBD. A risk factor is something that may increase the chance of developing a disease. Some risk factors can be controlled while others cannot. Age is considered the greatest risk factor. No specific lifestyle factor has been proven to increase one’s risk for LBD.
Other known risk factors for LBD include certain diseases and health conditions, particularly Parkinson’s disease and REM sleep behavior disorder, which have been linked to a higher risk of LBD.
Having a family member with LBD also may increase a person’s risk, though LBD is not considered a genetic disease. Variants in three genes APOE, SNCA, and GBA have been associated with an increased risk, but in most cases, the cause is unknown.
Symptoms Of Parkinson’s Disease
You can attribute the symptoms of Parkinson’s to a deficiency of a chemical in your brain called dopamine. The four classic motor symptoms of Parkinson’s include:
Shaking and tremors while you are resting is typically the first sign of Parkinson’s disease, but about one-third of patients won’t experience those symptoms. These symptoms tend to be worsened by emotional and physical stress. Sleep or moving can help reduce these issues.
Parkinson’s disease is both chronic and progressive with symptoms generally getting worse as time goes on. As it progresses, other disabilities can develop, including:
- Difficulty talking and swallowing
- A sudden inability to move,
Some sufferers also have symptoms that don’t affect their motor skills, including:
- Mental health issues such as anxiety, depression and memory loss
- Trouble sleeping, including thrashing and other sudden movements
- Change in blood pressure
Environmental Factors And Exposures
Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never having smoked cigarettes, and never drinking caffeinated beverages, are also associated with small increases in risk of developing PD.
Low concentrations of urate in the blood is associated with an increased risk of PD.
Drug-induced parkinsonism
Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:
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The Swedish National Parkinson Register Parkreg
The Swedish National registry for Parkinsons Disease , which was established in 2011 with the aim to contribute to Swedish Parkinson care through continuous follow-up of clinical measures and HRQoL instruments in clinical practice and through research. The register includes demographic variables, diagnosis, treatments, and physician reported clinical measures of disease severity, and patient reported outcomes. Information is included per clinical practice when the patients visit the doctor/nurse at the neurologists office, which is at least once a year. Due to the longitudinal nature of the study, patients were not necessarily assessed by the same neurologist at all visits. The registry currently covers at least one registration in approximately 6800 patients out of approximately 22 000 patients with Parkinson´s disease in Sweden. This study is based on data on patients from the southernmost region of Sweden, Scania, with idiopathic Parkinsons disease in PARKreg that was retrieved in April 2020.
The Scania Cohort of PARKreg has an estimated coverage of approximately 50% of patients diagnosed with PD in the region. Included patients were required to have at least one valid assessment of one of the study outcomes apart from treatment variables.
Theory Of Pd Progression: Braaks Hypothesis
Researchers believe a combination of genetic and environmental factors cause Parkinsons. In 2003, Heiko Braak, MD, hypothesized that an unknown pathogen in the gut could be the cause of PD.
This was followed by a more extensive hypothesis, stating that PD starts in two places: the neurons of the nasal cavity and the neurons in the gut. This is now known as Braaks hypothesis. In this theory, the pathogen enters the body via the nose and/or gets swallowed and reaches the gut. The pathogenic products thus come into contact with the olfactory and/or enteric neurons, triggering the aggregation of an abnormal protein called -Synuclein. The aggregated -Synuclein then spreads toward the central nervous system , and eventually arriving in and causing the degeneration of the dopaminergic neurons in the area of the brain called the substantia nigra.
This theory is supported by evidence that non-movement symptoms, such as a loss of sense of smell, sleep disorders and constipation, may appear several years ahead of movement symptoms. For this reason, researchers focus on these non-motor symptoms to detect PD as early as possible and to look for ways to stop its progression.
Page reviewed by Dr. Jun Yu, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
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How Is It Diagnosed
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.
How Is Parkinson Disease Treated
Dopaminergic medications are the mainstay of symptomatic therapy for motor symptoms in Parkinson disease. The mechanisms of action, starting and target doses and adverse effects of medications are summarized in Appendix 2, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.151179/-/DC1. Discovered in the 1960s, levodopa was the first symptomatic treatment for Parkinson disease, followed by the availability of dopamine agonists and monoamine oxidase B inhibitors. Until recently, the decision regarding which treatment to initiate has been debated. There is no one medication that is recommended for treatment initiation currently, but factors such as symptom severity, embarrassment, ability to perform activities, cost and patient preference should be taken into account. If symptoms are very mild, the patient may choose not to begin therapy.,
Because patients with early-onset disease are more likely to develop levodopa-induced abnormal movements , dopamine agonists are often introduced as initial treatment however, this early advantage of dopamine agonists over levodopa diminishes over time . There is also some controversial evidence for neuroprotection with the monoamine oxidase B inhibitor rasagiline at the 1 mg daily dose however, its cost is not covered in most provinces and may require application to the exceptional access program, as is done in Ontario.
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Causes Of Parkinsons Disease
Parkinsons disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinsons disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
Managing Early Onset Parkinsons Disease
According to Dr. Gilbert, while PD tends to progress more slowly in younger people, managing the disease can be particularly challenging from a psychological and social standpoint.
Younger patients may be dating, or have young families, and are building their careers, she explained. All of a sudden, they are grappling with something that nobody else at their stage of life is familiar with. It can be incredibly isolating. But its important to realize that a PD diagnosis is not the end of their life. With the right perspective and support, they can continue to work, support their families and engage with friends and loved ones.
Dr. Gilbert recommends that once diagnosed, patients start building a care team headed by a neurologist ideally a movement disorder specialist. Other key members of a PD care team include physical and occupational therapists to help maximize fine and gross motor skills a speech pathologist to work on soft or garbled speech and a dietician to address dietary changes, weight loss and constipation.
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Early Symptoms Of Parkinson’s Can Be Overlooked
Symptoms of Parkinson’s disease are divided into 2 groups: motor symptoms and non-motor symptoms.
Early non-motor symptoms can be subtle and it’s possible to overlook them as signs of Parkinson’s: for example, anxiety and depression, fatigue, loss of smell, speech problems, difficulty sleeping, erectile dysfunction, incontinence and constipation. Another sign of Parkinson’s is handwriting that becomes smaller.
Motor symptoms of Parkinson’s can include tremor , slowness of movement , muscle rigidity and instability .
It’s possible for non-motor symptoms to start occurring up to a decade before any motor symptoms emerge. Years can pass before symptoms are obvious enough to make a person to go to the doctor.
There’s no ‘one size fits all’ when it comes to Parkinson’s disease different people will experience different symptoms, and of varying severity. One in 3 people, for example, won’t experience tremor.
On average, 37 people are diagnosed with Parkinson’s every day in Australia. Parkinson’s Australia
How Is The Diagnosis Made
Currently, diagnosis of Parkinson disease is based on clinical features from history and examination, and over time based on the response to dopamine agents and the development of motor fluctuations. Motor manifestations of the disorder begin asymmetrically, and commonly include a resting tremor, a soft voice , masked facies , small handwriting , stiffness , slowness of movements , shuffling steps and difficulties with balance. A classic symptom is resting tremor, usually affecting one upper limb, although 20% of patients do not have it 30% may first present with tremor in a lower extremity, and there may also be a lip, jaw or even tongue tremor at rest., Head and voice tremors are uncommon, and one should consider essential tremor in the differential diagnosis in such cases. Of all the major features, bradykinesia has the strongest correlation with the extent of dopamine deficiency. Diagnosis has been formalized by the criteria of the UK Parkinsons Disease Society Brain Bank, with diagnostic accuracy of up to 90% .
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Caring For Your Health With Parkinsons Disease
In addition to caring for your Parkinsons health, it is also important to care for your overall health. This means visiting your primary care physician periodically for preventive care like the annual flu shot and cancer screeningsfor example, a mammogram for breast cancer screening and a colonoscopy for colon cancer screening.
A primary care physician can also evaluate for risk factors related to heart attacks and strokes, and provide counseling on exercise, smoking, alcohol use, depression, or other mental health concerns. Regular visits to your primary care physician or neurologist will also allow them to catch bacterial infections like urinary tract infections before they get serious.
What Can I Expect If I Have This Condition
Parkinsons disease is a degenerative condition, meaning the effects on your brain get worse over time. However, this condition usually takes time to get worse. Most people have a normal life span with this condition.
You’ll need little to no help in the earlier stages and can keep living independently. As the effects worsen, youll need medication to limit how the symptoms affect you. Most medications, especially levodopa, are moderately or even very effective once your provider finds the minimum dose you need to treat your symptoms.
Most of the effects and symptoms are manageable with treatment, but the treatments become less effective and more complicated over time. Living independently will also become more and more difficult as the disease worsens.
How long does Parkinsons disease last?
Parkinsons disease isnt curable, which means its a permanent, life-long condition.
Whats the outlook for Parkinsons disease?
Parkinson’s disease isn’t fatal, but the symptoms and effects are often contributing factors to death. The average life expectancy for Parkinson’s disease in 1967 was a little under 10 years. Since then, the average life expectancy has increased by about 55%, rising to more than 14.5 years. That, combined with the fact that Parkinson’s diagnosis is much more likely after age 60, means this condition doesn’t often affect your life expectancy by more than a few years .
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The Impact Of Parkinsons Disease On Overall Health
Based on the Blue Cross Blue Shield Health Index, the overall health of those affected by Parkinsons is significantly lower than the general population. In 2017, the average BCBS Health Index for someone aged 30-64 with Parkinsons was 57, compared to 88 for the entire commercially insured population in this age range. This translates to an average of 10.7 years of healthy life lost for those with the condition compared to 3.4 years for the 30-64 population as a whole.4
Caring for someone with Parkinsons Disease
The majority of Parkinsons patients are cared for by informal caregivers, such as a family member. The physical, mental and emotional work this requires can be significant. The Impact of Caregiving on Mental and Physical Health found that caregivers have 26% poorer health compared to a benchmark population, as measured by the BCBS Health Index. In addition, a national survey conducted by the Blue Cross Blue Shield Association found that 1 in 4 unpaid caregivers are feeling more stress trying to balance work and family due to COVID-19.5
What Is Parkinsons Disease
Parkinsons disease is a condition where a part of your brain deteriorates, causing more severe symptoms over time. While this condition is best known for how it affects muscle control, balance and movement, it can also cause a wide range of other effects on your senses, thinking ability, mental health and more.
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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.
Treatment For Young Onset Parkinsons
To date, there is no known cure or way to prevent Parkinsons disease. However, research is ongoing and remarkable progress is being made. There is very real hope that the causes, whether genetic, environmental, or some combination of the two, will soon be identified and the precise effects of these causes on brain function will be understood. Although there is no cure for the disease at this time, by identifying symptoms and determining a proper course of treatment, most people with the disease are able to remain active and lead fulfilling lives.
Are there doctors who specialize in Parkinsons disease?
Doctors who are specially trained to diagnose and treat conditions of the brain and nervous system are called neurologists. Some neurologists have a subspecialty in movement disorders and work extensively with patients who have Parkinsons disease and other similar conditions. These doctors also may have experience dealing with early onset Parkinsons symptoms. You can ask your physician if they have specific experience with younger patients, or whether they can refer you to a doctor who does.
How do I find a Parkinsons disease specialist?
Early Onset Resources
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Eat Healthy Meals Throughout The Day
- Consuming a variety of foods from all five food groups provides consistent energy and keeps your immune system healthy. Focus on eating a minimum of five fruits and vegetables each day, eating a variety of high fiber foods, and staying hydrated, all of which help prevent constipation, which is often an issue for people diagnosed with YOPD.
- Watch this to learn how to use nutrition to help you live well with Parkinsons.
Parkinsons Disease Is A Progressive Disorder
Parkinsons Disease is a slowly progressive neurodegenerative disorder that primarily affects movement and, in some cases, cognition. Individuals with PD may have a slightly shorter life span compared to healthy individuals of the same age group. According to the Michael J. Fox Foundation for Parkinsons Research, patients usually begin developing Parkinsons symptoms around age 60. Many people with PD live between 10 and 20 years after being diagnosed. However, a patients age and general health status factor into the accuracy of this estimate.
While there is no cure for Parkinsons disease, many patients are only mildly affected and need no treatment for several years after their initial diagnosis. However, PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. This progression occurs more quickly in some people than in others.
Pharmaceutical and surgical interventions can help manage some of the symptoms, like bradykinesia , rigidity or tremor , but not much can be done to slow the overall progression of the disease. Over time, shaking, which affects most PD patients, may begin to interfere with daily activities and ones quality of life.
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Social Isolation And Depression In Older Adults
Everyone needs social connections to survive and thrive. But as people age, they often find themselves spending more time alone. Studies show that loneliness and social isolation are associated with higher rates of depression.
If youre feeling socially isolated or lonely, and you cannot see your friends and family in person for any reason, try reaching out over the phone or joining a virtual club. Find tips to help you stay more connected.