Lewy body dementia
Lewy body dementia (LBD), also known under a variety of other names including dementia with Lewy bodies (DLB), diffuse Lewy body disease, cortical Lewy body disease, and senile dementia of Lewy type, is a type of dementia closely associated with Parkinson’s disease. Lewy body dementia affects 1.3 million individuals in the United States alone.
Signs and Symptoms
Lewy body dementia (LBD) primarily affects older adults. Its main feature is cognitive decline and hallucinations, as well as varied attention and alertness. Persons with LBD show markedly fluctuating cognition. Wakefulness varies from day to day, and alertness and short term memory rise and fall. Persistent or recurring visual hallucinations with vivid and detailed pictures are often an early diagnostic symptom. Falls are common. REM sleep behavior disorder (RBD) is a symptom often first recognized by the patient’s caretaker. RBD includes vivid dreaming, purposeful or violent movements while asleep, and falling out of bed.
Visual Hallucinations in LBD
Visual hallucinations in people with LBD most often involve seeing people or animals that are not there. These hallucinations are not necessarily disturbing and in some cases, the person with LBD may have insight into the hallucinations and even be amused by them or aware they are not really there. People with LBD may also have problems with vision, including double vision and misinterpretation of what they see, for example, mistaking a pile of socks for snakes or a clothes closet for the bathroom.
LBD, Alzheimer’s and Parkinson’s Diseases
LBD symptoms overlap clinically with Alzheimer’s disease and Parkinson’s disease. Because of this overlap, LBD in its early years is often misdiagnosed. However, whereas Alzheimer’s disease usually begins gradually, LBD frequently has a rapid or acute onset, with especially rapid decline in the first few months. Thus, LBD tends to progress more rapidly than Alzheimer’s disease. Despite the difficulty, a prompt diagnosis is important because of the risks of sensitivity to certain neuroleptic (antipsychotic) drugs and because appropriate treatment of symptoms can improve life for both the person with LBD and the person’s caregivers.
LBD is distinguished from Parkinson’s disease dementia by the time frame in which dementia symptoms appear relative to Parkinson symptoms. Parkinson’s disease with dementia (PDD) would be the diagnosis when dementia onset is more than a year after the onset of Parkinson’s. LBD is diagnosed when cognitive symptoms begin at the same time or within a year of Parkinson symptoms.
Treatment
Certain medications could be extremely harmful to patients with LBD. Benzodiazepines, anticholinergics, surgical anesthetics, some antidepressants, and over the counter cold remedies can cause acute confusion, delusions and hallucinations.
One of the most critical and distinctive clinical features of LBD is hypersensitivity to neuroleptic and antiemetic medications. In nearly 50% of cases, a patient treated with these drugs could lose cognitive function completely or develop life-threatening muscle rigidity, and die. Some commonly used drugs which should not be used for people with LBD are chlorpromazine, haloperidol, or thioridazine, risperidone, olanzapine and aripiprazole.
There is no cure for LBD. Treatment may offer symptomatic relief, but remains palliative in nature. Due to hypersensitivity to neuroleptics (drugs to treat hallucinations and delusions), people with LBD are at risk for neuroleptic sensitivity syndrome, a life-threatening condition. Other medications, including drugs for urinary incontinence and the antihistamine medication Benadryl can also exacerbate dementia.
As with most medical conditions, a timely evaluation by a physician specializing in diagnosis and treatment of memory disorders is the best approach to assuring the optimal outcome of a memory problem.
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