Does Lewy Body Dementia Have Stages? How Does It Progress?

Physician Explaining Lewy Body Dementia
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If you or someone you know has recently been diagnosed with Lewy body dementia, you might be wondering what to expect as the disease progresses. Is there a fairly typical progression like Alzheimer's disease where it begins in early stages that are fairly uniform, then moves to middle stages and then to late stages? In Lewy body dementia, the answer is a bit more complicated.

Progression of Lewy Body Dementia

Lewy body dementia does not progress the same way Alzheimer's disease does.

It does have characteristics that often can be categorized as likely to occur in the earlier stages, and other symptoms that are likely to develop as it progresses. However, a major difference in Lewy body dementia is that its symptoms can significantly fluctuate. 

In fact, one of the hallmarks of Lewy body dementia is fluctuation of cognitive functioning. For example, the memory of a person with Lewy body dementia might function fairly well one day and the next day, he may appear to be totally disengaged and exhibit poor memory. Understanding this variation in cognition can be helpful for caregivers because, without this knowledge, it can feel like the person with Lewy body dementia is "forgetting" on purpose.

This fluctuation can also make it feel like the person is moving back and forth from one stage to another, while in truth, variation in functioning is typically a constant within each stage of the disease.

Additionally, the rate of progression of Lewy body dementia varies significantly per person. The average lifespan of Lewy body dementia after diagnosis is about five to seven years; however, this can range anywhere from two to 20 years according to the Lewy Body Dementia Association.

Early Stages

In general, the earlier stages of Lewy body dementia may involve hallucinations or other distortions of reality such as delusions, restlessness, acting out dreams during sleep (called REM sleep disorder), and some movement difficulties.

Some people may appear to "freeze" or get stuck as they're moving around, and others may develop urinary urgency and incontinence. Unlike Alzheimer's disease, memory is usually still pretty intact in the early stages.

Middle Stages

As Lewy body dementia progresses towards its middle stages, symptoms develop that more strongly resemble Parkinson's such as increased impairment of the body's motor functions and falls, difficulty with speech, impaired ability to swallow and increased paranoia and delusions. Cognition also continues to decline and these changes often include decreased attention and significant periods of confusion. 

Later Stages

In the later symptoms of Lewy body dementia, extreme muscle rigidity and sensitivity to touch develops. Care becomes necessary for almost all activities of daily living. Speech is often very difficult and may be whispered or absent. Lewy body dementia typically causes the individual to become very susceptible to pneumonia and other infections due to weakness, which may eventually be the cause of death. 

Sources:

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

Lewy Body Dementia Association. Caregiver FAQ.

https://www.lbda.org/node/196 

Lewy Body Dementia Association. Diagnosis. https://www.lbda.org/content/diagnosis​

Lewy Body Dementia Association. The Role of Palliative and Hospice Care in Lewy Body Dementia. https://www.lbda.org/content/role-palliative-and-hospice-care-in-lbd#course​

University of Florida. AlzOnline. Lewy Body Dementia. http://alzonline.phhp.ufl.edu/en/reading/lewybody.php

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