Diagnosis and Management of Dementia with Lewy Bodies
Lewy body dementia (LBD) is a common type of dementia that occurs when protein clumps known as Lewy bodies accumulate in the brain. They cause damage to brain regions involved in thought, behaviour, movement, and sleep. Because LBD is a degenerative disorder, it worsens over time. Although there is no cure, medications and treatments can help manage symptoms. Because Lewy body dementia is a degenerative disease, symptoms appear gradually and worsen over time.
LBD is one of the most common causes of dementia in people over the age of 65. Symptoms of LBD may resemble those of Parkinson’s disease and Alzheimer’s disease, among other neurological disorders.
LBD cannot be cured, however, various drugs can help manage the symptoms. Non-medical treatments like physical therapy and speech therapy may also help you or a loved one.
Today, we know that there are different types of dementia, but here, we’ll learn about the various methods of diagnosing and treating dementia in Lewy bodies.
Signs and Symptoms
The symptoms of Lewy body dementia (LBD) can be mistaken for those of Parkinson’s disease and Alzheimer’s disease. Over time and from person to person, symptoms change.
There are a number of potential LBD symptoms, which can be categorized into the following types:
- Sleeping problems: Sleep abnormalities, such as rapid eye movement (REM) sleep behavior disorder, are common in people with LBD (RBD). This disorder causes yelling or speaking while sleeping, as well as frequent motions such as flailing or striking. When RBD patients awaken, they frequently have difficulty distinguishing between their dreams and reality.
- Dysautonomia: The common issue shared by a variety of diseases collectively known as dysautonomia is a malfunctioning autonomic nervous system (ANS).
The autonomic nervous system (ANS) of your nervous system regulates a wide range of automatic bodily processes, including heart rate, blood pressure, respiration, digestion, and many others.
- Mood and behavior changes: The behavior and mental abnormalities that LBD patients may encounter could get worse as their capacity for thought deteriorates.
- Movement issues: Significant movement problems may not appear for years in some LBD patients, while they may appear immediately in others. Movement symptoms can initially be minor and easily overlooked.
- Cognitive symptoms: Fluctuating cognitive (mental) function is a distinctive feature of Lewy body dementia. A person suffering from LBD may experience periods of clarity and alertness, as well as periods of perplexity and inability to respond to inquiries. This can change throughout the day or from day to day.
Stages of Lew Body Dementia
Because the symptoms of the disease can be confused with those of other brain disorders, diagnosing it can be difficult. Physical limitations are common in DLB. Individuals may begin to experience hallucinations, behavioural changes, and thinking and memory issues similar to Alzheimer’s disease within a year. The seven stages of LBD are as follows:
Stage 1: Absolutely normal phase
- Patients are completely normal in the absence of symptoms.
- Incidental discoveries on brain scans may be seen during normal tests using computed tomography or magnetic resonance imaging (CT).
- Some people experience daytime sleepiness, hallucinations, and mood swings.
Stage 2: Extremely minor symptoms
- Small signs that are impossible or difficult to detect
- Obliviousness to light (forgetting names or having trouble locating familiar objects)
- Patients may be able to resume their regular jobs and activities.
Stage 3: Mild symptoms that may still exist include
- Mild memory loss, forgetfulness, and attention problems.
- Increased risk of falling
- Having difficulty performing their daily tasks and jobs
Stage 4: At this point, patients frequently receive a confirmed diagnosis. Moderate signs and symptoms include
- Choking, difficulty swallowing, aspiration, and excessive drooling are the most common symptoms.
- Patients frequently have difficulty speaking and tremors.
- Irreversible memory loss
- Performing routine tasks with difficulty
Stage 5: Symptoms are often mild to moderately severe.
- Significant memory loss and the possibility of difficulty with daily tasks
- Significantly perplexed, befuddled, and possibly incapable of living alone any longer
- Patients are at high risk of infections and skin conditions, and they frequently have fever.
- Perhaps constant surveillance is required.
- Unable to perform even basic tasks
Stage 6: This typically lasts 2.5 years. Most symptoms have largely become more severe.
- The most typical incontinence symptoms at this period are urinary and bowel.
- Typically, patients lose their capacity to talk
- Patients might only be able to recall events from their childhood.
- Require a lot of assistance to live comfortably
- Memory loss that has worsened, trouble identifying family members, and some personality changes
Stage 7: Extremely bad symptoms. Normally, stage seven lasts for 1.5 to 2.5 years.
- Communication is restricted and physical systems may also deteriorate in this final stage.
- Late-stage dementia patients are unable to walk, need significant assistance with daily activities, and may require round-the-clock care.
How does Lewy Body Dementia Develop?
Both dementia with Lewy bodies and Parkinson’s disease Dementia is caused by an accumulation of Lewy bodies (proteins known as alpha-synuclein). When Lewy bodies accumulate in neurons, they cause damage to specific areas of your brain. Researchers are baffled as to why some people experience LBD while others do not. Certain individuals may develop LBD as a result of a genetic mutation, environmental risk factors, or natural aging. There is ongoing research into specific causes.
Finding an increasing number of gene mutations is one of the most recent developments in the search for a cause of Lewy body dementia. Variants in the APOE and GBA genes are two newer genetic risk factors.
Alzheimer’s disease risk has already been linked to APOE. There is mounting evidence that it also increases the risk of dementia with Lewy bodies. The GBA gene also increases the risk of Lewy body dementia and Parkinson’s disease. Despite these findings, scientists believe that genetic changes are a rare cause of LBD. The majority of cases of Lewy body dementia are not thought to be inherited (passed down from parent to child).
Diagnoses
Lewy body dementia (LBD) can be difficult to diagnose. Early LBD symptoms are frequently mistaken for those of other psychiatric or brain disorders. There are currently no medical diagnostics that can accurately identify Lewy body dementia. Several specialists may be needed for a diagnosis, such as:
- Neuropsychologists.
- Geriatricians.
- Neurologists.
- Geriatric psychiatrists.
They can jointly determine that the diagnosis is “probable LBD” based on the combined findings of the tests and symptoms.
A diagnosis of LBD is considered probable if two of the four core symptoms listed below are present, and feasible if only one is present, along with a history of gradual cognitive loss that interferes with daily activities:
- cognitive and behavioral changes.
- visual hallucinations that recur.
- disturbance of REM (rapid eye movement) sleep behavior.
- Parkinsonism.
Some Parkinson’s disease patients who develop cognitive symptoms less than a year after the onset of movement problems may have Lewy body dementia.
Medical professionals use the following techniques to identify LBD and rule out other illnesses with symptoms similar to LBD:
- History: A complete medical history and physical examination will be performed. Your doctor will ask about the onset of your symptoms. Inform them of any physical, mental, sensory, emotional, behavioral, movement, sleep, or other changes. They may also question your loved ones and relatives about your symptoms. Also, inform your doctor if you are currently taking any prescription drugs, over-the-counter medications, dietary supplements, vitamins, or herbal products.
- Neurological examination: It evaluates cognitive abilities such as memory, word retrieval, focus, and visual-spatial aptitude.
- Blood tests: Your doctor may order specific blood tests, such as thyroid blood tests, vitamin B12 levels tests, and tests for diseases such as syphilis and HIV. These tests can help to rule out potential dementia causes.
- Imaging testing: Because the abnormalities in your brain caused by LBD can sometimes be mistaken for those found in people with vascular dementia, imaging procedures such as an MRI and CT scan aren’t usually used to help diagnose Lewy body dementia. They can, however, help to rule out other possible causes of your symptoms, such as tumours or brain bleeding.
- Sleep studies: To check for REM sleep behavior disorder, your doctor can advise having sleep tests done. It entails spending the night in a lab. Sensors track your pulse rate, brain activity, breathing patterns, arm and leg movements, vocalizations, and more throughout the test. In order to track your actions during REM sleep cycles, you might also be recorded.
Treatments
For Lewy body dementia, there is no treatment (LBD). Symptoms are managed to the greatest extent feasible by medications and non-medical therapy like physical, occupational, and speech therapies.
The following medicines can be used to treat LBD symptoms:
- Selected serotonin reuptake inhibitors are frequently used in antidepressant therapy since depression is widespread in persons with LBD (SSRIs).
- Pimavanserin: This drug can be used to treat Parkinson’s disease dementia patients who are experiencing psychosis (hallucinations, delusions).
- Melatonin and clonazepam are two drugs that can be used to treat REM sleep behavior disorder.
- Memantine: This medication has been studied in clinical trials and may be effective in treating persons with LBD who are still in the early stages of the disease. Memantine is commonly used to treat dementia brought on by Alzheimer’s disease.
- Levodopa, a medication frequently used to treat Parkinson’s disease, is typically used to treat parkinsonism symptoms including tremors. Carbidopa with levodopa. But it has harmful side effects that might cause confusion, hallucinations, and delusions.
To enhance their quality of life, people with LBD can participate in a variety of therapies, including:
- Physiotherapy.
- Occupational medicine.
- Speech treatment.
- Support networks
- Family and individual psychotherapies (talk therapies).
- Exercise.
Palliative care, which offers symptom relief, comfort, and support to people living with serious illnesses, may be more appropriate in advanced cases of Lewy body dementia than aggressive medical interventions or inpatient care.
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Bottom Line
People with Lewy body dementia frequently experience a variety of emotions, including confusion, annoyance, anger, fear, unease, grief, and depression. Support someone by listening, assuring them that they can still enjoy life, staying positive, and doing everything you can to help them maintain their dignity and sense of self-respect.
Care partners or family members of people with Lewy body dementia should monitor them closely to prevent trips, pass outs, or drug reactions. Give comfort in times of confusion, delusions, or hallucinations.
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