Is it Lewy body disease?
Lewy body disease or Lewy body dementia accounts for 20-40% of dementias and is a dementia causing progressive cognitive and behavioral difficulties. It is the second most common form of dementia after Alzheimer's disease. It received its name due to the fact that nerve cells accumulate microscopic protein deposits called Lewy bodies. Lewy bodies are also found in the nerve cells of people with Parkinson’s disease.
The clinical symptoms can overlap those seen in Parkinson’s disease and Alzheimer’s disease so diagnosis is sometimes difficult.
For this reason the Lewy body disease consortium, a panel of leading scientific experts convened and issued this statement to help diagnosis:
- If the cognitive or behavioral problems are present from the beginning or within one year from the onset of Parkinson’s motor symptoms then the diagnosis is Lewy Body disease.
- If Parkinson’s movement symptoms have been present for greater than one year and then the person experiences cognitive behavioral problems (not caused by other problems) severe enough to be labeled dementia then the diagnosis is Parkinson’s disease with dementia.
What are the symptoms?
The major symptoms of LBD include change in a person’s cognitive abilities and behavior. These changes significantly impact daily living and are listed below:
- Changes in alertness and attention – this is often described as a changing or fluctuating level of alertness or ability for a person throughout the day. Clues to the presence of fluctuations include excessive daytime drowsiness (if nighttime sleep is adequate) or daytime sleep longer than 2 hours, staring into space for long periods, and episodes of disorganized speech.Hallucinations, confusion, agitation – these symptoms can be caused by medications such as typical antipsychotics and other medicines that affect brain function.
- Problems with movement and posture. These symptoms may be similar to Parkinson’s movement problems.
- Cognitive problems similar to executive dysfunction seen in Parkinson’s disease. Memory is affected but usually less severe early in the course than that seen with Alzheimer’s disease.
- Vivid dreaming, active dreaming or a condition called REM Sleep Disorder
What are the treatments?
Treatment is highly individualized. A Neurologist will typically complete a thorough neurological examination, and testing of cognitive functions. A neuropsychological testing may be helpful to further define the pattern and degree of thinking and behavioral changes. Blood work, brain imaging and other medical tests may be needed.
Treatment may require a careful review of all medicines to be sure no medication is worsening cognitive function or other behaviors. Cognitive enhancing medicines and specific treatment of hallucinations may be needed. More information about these treatments is available in 'Treating Dementia'. Treatment of mood, movement and sleep problems such as REMSD may be needed.
Your rehabilitation team can offer much support to help patients and family adapt to and manage difficulties with everyday life. The Comprehensive Care Worksheet can help you determine if any of these specialists can help. A Neuropsychologist is a specialist that can measure your cognitive abilities and offer strategies to enhance your strengths and work with any weaknesses. A counselor or psychologist can help you or your carepartner manage the many stressors that you or your family encounter. Finally a visit with a social worker is good place to start to learn more about life planning and other living assistance needs.
How can I find out more?
The Lewy Body dementia Association has more information and helpful types for those living with this condition. Visit their website at http://www.lbda.org/.