Dementia with Lewy Bodies

Symptoms

Lewy body dementia signs and symptoms may include:

• Visual Hallucinations - Hallucinations may be one of the first symptoms, and they often recur. They may include seeing shapes, animals or people that aren't there. Sound (auditory), smell (olfactory) or touch (tactile) hallucinations are possible. Movement disorders - Signs of Parkinson's disease (parkinsonian signs), such as slowed movement, rigid muscles, tremor or a shuffling walk may occur. This can also result in falls.
• Poor regulation of body functions (autonomic nervous system) - Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy body dementia. This can result in dizziness, falls and bowel issues such as constipation.
• Cognitive problems - You may experience thinking (cognitive) problems similar to those of Alzheimer's disease, such as confusion, poor attention, visual-spatial problems and memory loss.
• Sleep difficulties - You may have rapid eye movement (REM) sleep behaviour disorder, which can cause you to physically act out your dreams while you're asleep.
• Fluctuating attention - Episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.
• Depression - You may experience depression sometime during the course of your illness.
• Apathy - You may have loss of motivation.

Causes

Lewy body dementia is characterized by the abnormal build-up of proteins into masses known as Lewy bodies. This protein is also associated with Parkinson's disease.

People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer's disease.

Risk Factors

A few factors seem to increase the risk of developing Lewy body dementia, including:

• Age - People older than 60 are at greater risk.
• Sex - Lewy body dementia affects more men than women.
• Family history - Those who have a family member with Lewy body dementia or Parkinson's disease are at greater risk.

Diagnosis

As with other types of dementia there is no single test that can conclusively diagnose dementia with Lewy bodies. Today, DLB is a ‘clinical’ diagnosis, which means it represents a doctor's best professional judgment about the reason for a person's symptoms. The only way to conclusively diagnose DLB is through a post-mortem autopsy. Many experts now believe that DLB and Parkinson's disease dementia are two different expressions of the same underlying problems with brain processing of the protein alpha-synuclein. But most experts recommend continuing to diagnose DLB and Parkinson's dementia as separate disorders. The diagnosis is DLB when:

• Dementia symptoms consistent with DLB develop first
• When both dementia symptoms and movement symptoms are present at the time of diagnosis
• When dementia symptoms appear within one year after movement symptoms.

Treatment

There are no treatments that can slow or stop the brain cell damage caused by dementia with Lewy bodies. Current strategies focus on helping symptoms.

If your treatment plan includes medication, it's important to work closely with your physician to identify the drugs that work best for you and the most effective doses. Treatment considerations involving medications include the following issues: Cholinesterase inhibiltors drugs are the current mainstay for treating thinking changes in Alzheimer's. They also may help certain DLB symptoms.

Antipsychotic drugs should be used with extreme caution in DLB. Although physicians sometimes prescribe these drugs for behavioural symptoms that can occur in Alzheimer's, they may cause serious side effects in as many as 50 percent of those with DLB. Side effects may include sudden changes in consciousness, impaired swallowing, acute confusion, episodes of delusions or hallucinations, or appearance or worsening of Parkinson's symptoms.

Antidepressants may be used to treat depression, which is common with DLB, Parkinson's disease dementia and Alzheimer's.The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs).

Clonazepam may be prescribed to treat REM sleep disorder.