Most people mistakenly believe that all types of dementia share similar symptoms, like the hallmark signs of forgetfulness and confusion that are associated with Alzheimer’s disease (AD). However, Lewy body dementia (LBD), the second most common type after AD, is characterized by unique symptoms that make it difficult to diagnose and treat.
It’s important for family caregivers who are looking after aging loved ones to familiarize themselves with some of the basic signs of various age-related diseases like LBD. Noticing strange new behaviors or quirks early on can help ensure a senior gets the medical attention they need in a timely manner.
Facts About Lewy Body Dementia
- It affects millions of seniors.
According to the Lewy Body Dementia Association, LBD affects approximately 1.4 million individuals and their families. Although it is widely unknown, it is the second most common form of dementia after Alzheimer’s disease.
- LBD is not Alzheimer’s disease.
Many people use the terms “dementia” and “Alzheimer’s disease” interchangeably, but dementia is an umbrella term used to describe a progressive neurological disorder that affects cognitive function, of which there are many different kinds. Alzheimer’s is one form of dementia that is characterized by impaired memory, issues with decision making, trouble with problem solving and difficulty learning new skills.
There are crucial differences between AD and LBD. For one thing, people with LBD experience unpredictable changes in cognition, regardless of the time of day, whereas people with Alzheimer’s tend to have more trouble in the late afternoon and evening—a symptom known as “sundowning.” Those with LBD also tend to have more visual hallucinations and movement issues, while the hallmarks of AD include memory loss and trouble performing familiar tasks. Furthermore, abnormal alpha-synuclein protein deposits in the brain called Lewy bodies are the hallmark biological marker of LBD, unlike Alzheimer’s, which is caused by the accumulation of beta-amyloid plaques and tau tangles in brain tissue.
- LBD is difficult to diagnose.
As with Alzheimer’s, LBD can only be conclusively diagnosed through an examination of brain tissue after a person has died. However, medical advancements have significantly improved the certainty with which doctors can diagnose living patients.
Doctors consider the person’s symptoms, interview their family members, perform physical and mental evaluations, obtain a family and personal medical history, and conduct blood tests and brain imaging tests like MRI, PET and CT scans. Symptoms of LBD include problems with depth perception, hallucinations (often visual), delusions, paranoia, Parkinsonism (body stiffness, tremors, trouble walking), and physical issues like heart rate and blood pressure fluctuations, constipation, and fainting spells. To be diagnosed with LBD, an individual must have dementia as well as several of these symptoms.
- Medications and LBD can have adverse interactions.
An accurate, timely diagnosis of LBD is essential to avoiding dangerous medication reactions. Many drugs prescribed to people with Alzheimer’s disease and Parkinson’s disease—especially antipsychotic drugs used to control hallucinations—can have a dangerous effect on people with LBD. Neuroleptic malignant syndrome (NMS) is a neurological disorder brought on by a negative reaction to antipsychotic medications that often occurs in people with LBD. Individuals who develop NMS can experience muscular rigidity, high fever, variable blood pressure and severe sweating. Anticholinergic medications, benzodiazepines and over-the-counter sleeping pills can also have negative effects on seniors with Lewy body dementia.
- Parkinson’s disease and LBD are very similar.
People with LBD often exhibit the same symptoms as those with Parkinson’s disease dementia (PDD). While the two conditions start off differently, their biological underpinnings are closely related, and people with Parkinson’s disease can be diagnosed with either PDD or LBD. The factor that physicians use to distinguish between these two conditions is the timing of the onset of cognitive symptoms. People who develop dementia within a year of their Parkinson’s diagnosis are thought to have LBD, while those whose dementia symptoms start beyond the one-year mark are thought to have PDD.
- LBD affects sleep quality.
Sleep issues and dementia often go hand in hand, but there’s a specific sleep condition that appears to disproportionately affect people with LBD. Studies indicate that as many as two-thirds of LBD patients struggle with REM sleep behavior disorder (RBD). RBD is an ailment that causes movement, speaking and gesturing during the REM (rapid eye movement) stage of sleep, which is usually characterized by paralysis in healthy individuals.
- Like most dementias, LBD is unpredictable.
One of the biggest challenges facing seniors with LBD and their families is the fact that symptoms of the disease tend to worsen and improve erratically. Periods of mental fog, aggressive behavior, movement issues and vivid hallucinations can last seconds, minutes, hours or days. Fluctuations in symptoms can be caused by underlying infections, medications or general progression of the disease. Because of this, it can be nearly impossible to determine how far LBD has progressed in a given individual. However, if the exacerbating factor is capable of being fixed (like a urinary tract infection), then the person with LBD can often return to their prior level of functioning after receiving treatment for the secondary issue.
- LBD has no cure.
There is currently no way to cure or halt the progression of LBD. Instead, treatments are aimed at controlling the cognitive, psychiatric and motor symptoms of the disorder. Those who have been diagnosed with the condition may benefit from palliative care, which focuses on using drugs and nonpharmaceutical treatments to manage symptoms and improve a patient’s comfort and quality of life. For instance, cognitive issues may be addressed with cholinesterase inhibitors, a type of medication that promotes brain cell function by regulating the neurotransmitter acetylcholine. To improve sleep quality and minimize the effects of RBD, careful treatment with clonazepam (Klonopin) or melatonin might be prescribed. Levodopa may be used to mitigate the motor effects of severe Parkinsonism. Occupational, speech and physical therapies are the most common nonpharmaceutical approaches to helping people with LBD manage their condition and maintain day-to-day functionality. Average life expectancy after diagnosis is about 8 years, with progressively increasing cognitive and functional disability.
Source: The National Institute of Neurological Disorders and Stroke (NINDS) , https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia-Lewy-Bodies-Information-Page