Lewy Body Dementia

Lewy body dementia is a type of dementia in which proteins accumulate in the cells of the brain leading to problems with thinking, memory and movement.

It is the second most common type of progressive dementai after Alzheimer's disease.

Symptoms that people with Lewy body dementia experience may include

• hallucinations,
• changes in alertness and attention,
• muscle rigidity,
• slow movement and tremors.

LBD or Lewy Body Dementia is considered to be a progressive form of brain related disorder. In this disorder, Lewy bodies which are actually abnormal deposits of a protein called alpha-synuclein tend to build up in certain areas of the brain that regulate movement, behavior and cognition in the individual. LBD is termed as a complex form of disease which has a range of symptoms as mentioned earlier. This disease is also known to impact the autonomic body functions which would include blood pressure control, bladder or bowel related functions or regulation of temperature.

Now you might be wondering how the name Lewy bodies did originate and who was Lewy? In the early 1900s, during the research of Parkinson’s disease, a scientist by the name of Friederich Lewy had discovered deposits of an abnormal protein which would lead to disruption in the normal functioning of the brain. These Lewy proteins were said to be found in a certain area of the brain stem wherein they would deplete the neurotransmitter dopamine, thereby leading to the symptoms of Parkinson’s disease.

In Lewy body dementia, these abnormal looking proteins diffuse into the other areas of the brain including the cerebral cortex. Acetylcholine which is a brain chemical gets depleted leading to disruption of the perception, behavior and thinking of the individual. This Lewy body dementia is known to exist in its pure form or it can also be in conjunction with certain other brain related changes which can also include those which are mostly seen in Parkinson’s disease or Alzheimer’s disease.

There has not been any definite cure or treatment which has been discovered for Lewy body dementia yet. It has been researched that this disease has an average duration of five to seven years. But it is also possible for the time span to increase and fall anywhere between two to twenty years for an individual. This would also be dependent on a lot of factors such as the overall health of the individual, age, the severity of the symptoms affecting the individual and the response of the individual to the medicines.

It gets very difficult to define the stages of the progression of this disease. There are various things such as symptoms the individual is experiencing, management of medicine and the duration of this disease would also vary from one individual to another. The stages assessment is further complicated because this disease has a progressive but vacillating course and one of the defining symptoms is fluctuating levels of cognitive skills in the individual along with attention and alertness. Sudden reduction is often known to be caused due to medications, infections or any other compromises which occur to the immune system. But in case of certain individuals, it can also be due to the natural course of the disease.

Signs and symptoms of Lewy body dementia may include the following:

• Visual hallucinations
• Touch, smell and sound hallucinations
• Movement disorders such as slowed movements, rigid muscles or tremors
• Poor regulation of  body functions like blood pressure, pulse, sweating and  digestive processes which are regulated by the autonomic nervous system
• Problems with thinking and memory
• Sleeping disorders
• Problems with attention
• Depression and apathy

Lewy body dementia is caused by accumulation of proteins, known as Lewy bodies, in the brain.

People with this type of dementia may also have plaques and tangles as seen in Alzheimers disease.

Tests that can be used for the diagnosis of Lewy body dementia include:

Neurological and physical exams

Doctors may test:

• reflexes,
• muscle strength and tone,
• eye movements,
• ability to walk,
• balance
• sense of touch.

These exams are also used for checking signs of:

• Parkinson's disease,
• strokes,
• tumors
• any other conditions that are accompanied by symptoms.

Tests to check the mental abilities are used to  assess the memory and thinking ability of the patient.

These tests are helpful as they can help distinguish Lewy body dementia from Alzheimer's disease.

Blood tests can be used to check for other problems that can affect the function of the brain, like vitamin B-12 deficiency or hypothyroidism.

Brain imaging scans like MRI, CT or PET scans can be used to  make sure the function of the brain is not as a result of stroke, bleeding or tumor.

Like rivastigmine (Exelon) that increase the levels of chemical messengers present in the brain that are responsible for memory, thought and judgment can be used. Other drugs like carbidopa-levodopa (Sinemet) can also be administered to reduce Parkinsonian symptoms like muscle rigidity and slow movement. Patients taking these medications should be monitored since these medicines can lead to confusion, hallucinations and delusions.

Since LBD is considered to be a multi-system form of disease, there would typically be a need for comprehensive form of treatment approach. This would mean that there can be a team of various physicians from varied fields or specialties who would come together to provide the individual with the optimum course of treatment for each of the varied symptoms without worsening of the other forms of LBD symptoms. Before starting the course of treatment, it becomes very important to remember that certain people who are suffering from LBD are very sensitive or they have a tendency to react in a negative manner to certain medications which are used for treating Parkinson’s disease or Alzheimer’s disease apart from certain over-the-counter medications.

Treatment for cognitive symptoms

There are certain medications such as cholinesterase inhibitors which are considered to be a standard form of treatment for treating the cognitive symptoms caused due to LBD. These medications were initially developed to treat Alzheimer’s disease, but in various studies it was believed that individuals who were suffering from LBD may also give a positive response to such type of medications than those suffering from Alzheimer’s.

Treatment for visual hallucinations

Hallucinations are always disruptive or tend to upset the individual. In such cases, the doctor can recommend a cautious trial of certain new antipsychotic medications.

Treatment for movement related symptoms

Movement symptoms in an individual is said to be best treated with a Parkinson’s medication known as levodopa. However, if the movement symptoms are mild and there is nothing much to worry about, then it is always better to not get them treated to avoid any instances of a potential side effect of the medication.

Treatment for symptom such as neuroleptic sensitivity 

A severe form of sensitivity to neuroleptics is known to be quite common in patients suffering from LBD. Neuroleptics, also known as antipsychotics, are medications which are used for treating hallucinations or any other form of serious mental issues or disorder. The doctor can prescribe the traditional form of antipsychotic medications such as haloperidol which is said to be quite commonly prescribed for those individuals who suffer from Alzheimer’s with disruptive form of behavior.

These medications have a tendency to impact the brain of the individual suffering from LBD in a different way. At times, it can also lead to severe side effects. Hence to avoid such serious issues, the traditional antipsychotic drugs such as haloperidol should be avoided as much as possible.

There are some newer forms of atypical antipsychotic medications such as Risperidone which can also be a cause of concern for those who are suffering from LBD. As per some experts on LBD, medicine Quetiapine is preferred; however if this medicine is also not well tolerated or if it does not help in treating the symptoms, then the doctor can look to prescribe Clozapine. But for prescribing this medicine, the doctor would need ongoing blood tests to assure that there is no occurrence of a rare or a serious condition of blood which can tend to develop as a side effect. If there are hallucinations, then it should be treated conservatively by using the lowest possible dosages of the medicine and also under careful observation for any instances of side effects in the individual.

Non-drug therapies

Can also be used. Making modifications to the environment and creating daily routines and keeping simple tasks can be very helpful for patients with Lewy body dementia.

Alternative remedies that may help patients with Lewy body dementia to relax include:

• Music therapy
• Pet therapy
• Aromatherapy
• Massage therapy                                                                                                   

There are several risks and complications associated with Lewy body dementia.

Factors that may increase the risk of developing Lewy body dementia include:

• Adults older than 60
• Being male
• Having a family history of Lewy body dementia or Parkinson's disease

Because Lewy body dementia is a progressive disease, symptoms tend to get worse with time.

As result of this the following complications may arise:

• Severe dementia
• Aggressive behaviour
• Depression

An increased risk of falling and injury

• Worsening of symptoms like tremors
• Death