Symptoms, Treatment and Prognosis in Lewy Body Dementia

The Complete Guide to Lewy Body Dementia

Lewy Body Dementia Is One Kind of Dementia
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Although you may not be as familiar with Lewy body dementia as you are with Alzheimer's disease, it's widely considered the second most common type of dementia.

What is Lewy Body Dementia?

Lewy body dementia, or LBD, refers to a type of dementia associated with abnormal protein deposits in the brain called Lewy bodies, which affect how the brain functions.

What are the Common Symptoms of Lewy Body Dementia?

 People with Lewy body dementia commonly experience these symptoms:

  • Fluctuations in thinking, visuospatial ability, information processing, perception, speaking, finding words and recognizing things.
  • Movement problems, like stooped posture and lack of facial expression — most have symptoms of parkinsonism, meaning resembling those of Parkinson's disease.
  • Fluctuating alertness — for example, a person may become extremely drowsy, then suddenly have a burst of energy, making it difficult for family members to evaluate how their relative is doing.

  • Recurrent visual hallucinations, especially of people and animals. These often provoke an emotional reaction, even though the person might know they are not real.
  • REM Sleep Behavior Disorder, in which a person may act out their vivid dreams.
  • Behavioral and mood symptoms, including frequent falls, depression, and delusions.
  • Problems with memory, which tend to occur later in the disease.
  • Changes in autonomic body functions, such as blood pressure control, temperature regulation, and bladder and bowel function.

    Diagnosis of Lewy Body Dementia

    No singular test can definitively diagnose Lewy body dementia, as Lewy bodies can only be identified through a brain autopsy.

    As with Alzheimer's disease, a complete diagnostic workup should be performed in order to rule out other possible causes of the person's symptoms.

    This may include a magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain. 

    Lewy body dementia is typically diagnosed after other conditions are ruled out and the person's symptoms best fit with the diagnostic criteria for LBD. 

    Prognosis of Lewy Body Dementia

    The prognosis of someone with Lewy body dementia depends on multiple factors, including age of onset and overall health. On average, life expectancy with LBD is five to seven years, although the range is known to be between two and 20 years.

    Lewy body dementia doesn't typically progress as predictably as Alzheimer's does. Rather, because one of its characteristics is that its symptoms can fluctuate, progression in Lewy body dementia may vary significantly from one person to another.   

    Treatment of Lewy Body Dementia

    There is currently no cure for Lewy body dementia, but there are medications that can help with symptom management. While no drugs have been approved by the FDA to specifically treat it, Alzheimer's treatments have been shown to be helpful.

    It's interesting to note that some researchers have found that those with Lewy body dementia respond better to cholinesterase inhibitors, like Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine), than those with Alzheimer's disease.

    Because individuals with Lewy body dementia often have Parkinson's-like movement problems, medications for Parkinson's disease can sometimes treat related symptoms. However, they can also increase confusiondelusions, and hallucinations, so they are used carefully and with close monitoring by a person's doctor.

    Non-drug strategies may also be useful for managing the difficult behavioral symptoms of Lewy body dementia. For instance, physical therapy and speech therapy may be helpful. Simple strategies, like reducing caffeine intake and providing relaxing activities in the evening, may improve sleep patterns and decrease violent outbursts during the night. 

    In addition, antidepressants, like selective serotonin reuptake inhibitors, or SSRIs, can be used to treat the depression associated with Lewy body dementia.

    Finally, it's important to know that antipsychotic medications, which are often used to treat hallucinations and delusions, may have serious side effects which can be life-threatening for people who have Lewy body dementia. Extreme caution is called for if these medications are used for people with Lewy body dementia.   

    What Does This Mean for Me or My Loved One?

    If you or a loved one has been diagnosed with Lewy body dementia, be sure to address all your concerns and questions with your doctor. It's also a good idea to consider having a family meeting if you are ready and comfortable. This way you can discuss issues, like goals of care and treatment expectations. 

    Sources

    Alzheimer's Association. Dementia with Lewy Bodies. http://www.alz.org/dementia/dementia-with-lewy-bodies-symptoms.asp​

    Lewy Body Dementia Association. Diagnosis. https://www.lbda.org/content/lbd-booklet/lbd-diagnosis

    Lewy Body Dementia Association. Treatment. https://www.lbda.org/node/1316

    Zupancic M, Mahajan A & Handa K. Dementia with lewy bodies: diagnosis and management for primary care providers. Prim Care Companion CND Disord. 2011;13(5).

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