What Is Lewy Body Dementia?
Lewy body dementia (LBD) is a neurological disorder caused by aberrant microscopic deposits of the protein alpha-synuclein that destroy brain cells over time. These deposits, known as Lewy bodies, alter the brain's chemical balance, which causes a loss in thinking, movement, behavior, independent function, and mood. Lewy body dementia is a kind of progressive dementia and one of the most common causes of dementia.
After Alzheimer's disease, Lewy body dementia, commonly known as dementia with Lewy bodies, is the second most common type of progressive dementia. A gradual loss of cognition characterizes Lewy body dementia. In persons with Lewy body dementia, visual hallucinations and difficulties in attention and concentration are common. Other side effects include tight muscles, delayed movement, walking difficulty, and tremors, which are all signs and symptoms of Parkinson's disease.
What Is the Cause of Lewy Body Dementia?
Lewy body dementia is a broad-ranging umbrella term for two distinct neurological disorders:
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In dementia with Lewy bodies, problems with thinking, erratic transitions in attention and attentiveness, and visual hallucinations emerge early followed by movement symptoms such as slowness, trouble walking, and muscle stiffness.
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Dementia caused by Parkinson's disease begins with movement and is compatible with the diagnosis of the disease. Problems with thinking, as well as changes in mood and behavior, emerge later. Dementia does not affect everyone who has Parkinson's disease.
Both illnesses are caused by the same basic abnormalities in the brain. A person who has ‘dementia with Lewy bodies’ will develop dementia as well as other Lewy body dementia symptoms, one of which may be tremors or parkinsonism. Some people with the other type of LBD will first exhibit alterations in their movement, leading to a diagnosis of Parkinson's disease; nevertheless, most of them will develop dementia years later. The condition is known as ‘Parkinson's disease dementia.’
A protein called alpha-synuclein accumulates abnormally in areas of the brain important for thinking, memory, cognition, and movement in persons with LBD. Lewy bodies pile up inside the brain's neurons, or nerve cells, causing them to malfunction and finally die. Certain substances in the brain that serve as cell messengers are also impacted. It is still unknown what causes these alterations in the brain. Certain researchers believe that a person's genes, environmental risk factors, and natural aging may all contribute to the development of disease in some people. This disease can affect both men and women, but it is more frequent in men.
What Are the Symptoms and Signs of Lewy Body Dementia?
Changes in thinking ability, movement, sleep, and behavior are among the most typical signs of LBD. The severity of symptoms varies, and patients with LBD may not experience all of them. Symptoms that are common include:
- Dementia: It develops when the brain loses its ability to think, remember, and deduce information. Minor indicators of dementia include forgetting to pay a bill or asking the same questions repeatedly. With the progression of the disease and as time goes on, one may find themselves wandering away from home or unable to recognize loved ones' faces.
- Visual Hallucinations: When the patient starts to see things that are not there, visual hallucinations affect up to 80 percent of persons with LBD, and they often start early. Nonvisual hallucinations are less common than visual hallucinations, but they can happen as well, such as hearing or smelling things that are not there.
- Loss of Thinking Abilities: Rapidly changing cognitive function is a hallmark of LBD and is rather distinctive. Bouts of alertness, coherence, and orientation may alternate with periods of confusion and unresponsiveness to inquiries, usually over a time span of days to weeks but occasionally during the same interview.
- Movement and Body Functions: Slowed movement, tight muscles, tremors, or shuffling gait are all Parkinsonian signs, and they may result in a fall. Body functions are poorly regulated by the autonomic nervous system, a component of the neurological system frequently compromised by Lewy body dementia. It regulates blood pressure, pulse, perspiration, and the digestive process. Due to disturbances in the autonomic nervous system, sudden dip in blood pressure when standing, also known as orthostatic hypotension, giddiness, falls, loss of bladder control or urinary incontinence, and bowel problems like constipation.
- Behavior and Mood Changes: Depression, apathy or lack of interest in ordinary daily tasks or events, anxiety, as well as a lack of social engagement, are observed. Restlessness or agitation is also seen. Delusions and paranoia is characterized by an intense, unreasonable distrust of others, such as suspicions that others are stealing or hiding things.
- Sleep Behavior Disorder: One of the initial indicators of LBD could be these symptoms such as talking to oneself in sleep, tumbling out of bed, or moving forcefully while sleeping. These abnormal sleep patterns are accompanied by vivid dreams and are called Rapid eye movement (REM) sleep behavior disorder.
How Is Lewy Body Dementia Diagnosed?
The diagnosis is made based on the patient's indications and symptoms and the exclusion of other disorders that can cause similar symptoms. The following tests may be performed:
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Physical examination and complete medical history of the patient are two critical factors in determining the disease. A neurologist may ask relevant questions and perform a neurological examination to test for reflexes, strength, sense of touch, and eye movements.
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Brain scans such as MRI (magnetic resonance imaging), CT (computer tomography), and PET (positron emission tomography) can detect any changes in the structure and function of the brain. These tests also help doctors rule out other brain illnesses like stroke or cancer that might cause similar symptoms.
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Sleep and heart tests such as a polysomnogram or an autonomic function test can be performed to screen for REM sleep behavior disorder. Doctors may also request a heart test called myocardial scintigraphy to assess the heart's blood flow for signs of Lewy body dementia.
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Blood tests can reveal if your protein levels are abnormal. Doctors may also do tests to rule out other illnesses that cause similar symptoms.
What Is the Management and Treatment for Lewy Body Dementia?
There is no way to slow or stop the growth of the disease. On the other hand, treatment is prescribed to help one better control one’s symptoms and enhance the overall quality of life.
Medication:
Cholinesterase inhibitors may help people with Lewy body dementia or Parkinson's disease dementia improve their cognitive function. Extrapyramidal symptoms respond to antiparkinsonian medicines in roughly half of the individuals with Lewy body dementia. If such medications are required, Levodopa is the drug of choice. Traditional antipsychotics, even at extremely low doses, tend to exacerbate extrapyramidal symptoms in dementia with Lewy bodies and should be avoided.
Supportive Care and Therapies:
Because antipsychotic medicines might exacerbate the symptoms of Lewy body dementia, it is a good idea to explore non-drug options.
- Physical therapy is a type of treatment that involves the use of gait, strength, flexibility, and overall health can all benefit from this.
- Speech therapy can aid in the improvement of swallowing and speaking issues.
- Occupational therapy is a term used to describe a type of treatment. This can make simple things like eating and bathing easier and require less support from others. Making regular routines and keeping chores simple are both important. Break activities down into smaller parts and concentrate on accomplishments rather than failures.
- Counseling for mental health can aid the person with Lewy body dementia and their family in learning to cope with their emotions and actions.
Conclusion:
Lewy body dementia is a multi-system disease. It usually necessitates a multi-disciplinary treatment plan involving a team of physicians with other health care professionals such as occupational, physical, and speech therapists. Early detection and treatment can help one maintain independence and quality of life. With a complete treatment approach, many patients with Lewy body dementia have significant lifestyle improvements.
