LEWY BODY DEMENTIA (LBD)

Recently, Lewy body dementia has become popularly known due to a popular actor that was recently diagnosed with the condition in Nigeria. However, Lewy body dementia is the second most common type of progressive dementia after Alzheimer’s disease.  It is caused as a result of protein deposits, called Lewy bodies, which develop in nerve cells in the brain regions involved in thinking, memory, and movement. Lewy Body Dementia may get worse over time and shorten lifespan.

Risk Factors of Lewy Body Dementia

There are some factors that are likely to increase the risk of individuals developing dementia with Lewy body. These are:

  • Age: This is the biggest known risk factor. An individual older than 60 is at greater risk of developing Lewy Body Dementia.
  • Sex: Lewy body dementia affects more males than females.
  • Family history: People with a family member with Lewy body dementia or Parkinson’s disease are at greater risk of developing it.

Signs and Symptoms of Lewy Body Dementia

Some Lewy body dementia signs and symptoms include:

  • Visual hallucinations: This is a situation whereby an individual sees things that aren’t there.
  • Movement disorders: Such as slowed movement, rigid muscles, tremors, or a shuffling walk. This can also lead to falls if affected individuals are not closely monitored.
  • Poor regulation of body functions: Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy body dementia. This can result in sudden drops in blood pressure upon standing, dizziness, falls, loss of bladder control, and bowel issues such as constipation.
  • Cognitive problems: There can be unpredictable changes in concentration or alertness such as confusion, poor attention, visual-spatial problems, disorganization of ideas, and memory loss.
  • Sleep difficulties: This might involve behavior such as punching, kicking, yelling, and screaming while sleeping.
  • Fluctuating attention: Episodes of drowsiness, long periods of staring into space, long naps during the day, or disorganized speech are possible.
  • Depression: Depression is likely to set in if such an individual doesn’t have adequate support and care.

Diagnosis of dementia with Lewy body

         There are no definite tests that can diagnose Lewy Body Dementia. The diagnosis is based on signs and symptoms presented by an individual and ruling out other conditions that can cause similar signs and symptoms. To be able to ascertain Lewy body dementia, there must have been a progressive decline in ability to think, as well as at least two of the following:

  • Fluctuating alertness and thinking function
  • Repeated visual hallucinations
  • Parkinson’s symptoms such as tremors, slowed movement, rigid muscles, impaired posture and balance, speech changes, etc.
  • Sleep disorder which includes early awakening, nightmares, or restless sleep.

Below medical steps are taken before diagnosing Lewy Body Dementia:

A. Neurological and Physical Examination

The doctor may check for signs of Parkinson’s disease, strokes, tumors, or other medical conditions that can affect the brain and physical function. Neurological examination tests assess reflexes, strength, walking, muscle tone, eye movements, balance, and sense of touch.

B. Assessment of Mental Abilities

A short form of this test, which assesses memory and thinking skills, can be done in a few minutes in the doctor’s office.

C. Blood Tests

These can rule out other conditions that can affect brain function, such as stroke, Alzheimer’s disease, Brain cancer, etc.

D. Brain Scans

The doctor might order an EEG (electroencephalogram), MRI, or CT scan to identify a stroke or bleeding and to rule out a tumor. While dementias are diagnosed based on medical history and physical examination, certain features of imaging studies can suggest different types of dementia, such as Alzheimer’s or Lewy body dementia.

E. Sleep Evaluation

        A sleep evaluation called Polysomnography might be ordered to check for REM sleep behavior disorder or an autonomic function test to look for signs of heart rate and blood pressure instability.

F. Heart Test

            In some countries, doctors might also order a heart test called Myocardial Scintigraphy to check the blood flow to the muscle of the heart at rest and during exercise for indications of Lewy body dementia.

Treatment of Lewy Body Dementia

           There’s no cure for Lewy body dementia but many of the symptoms can improve with targeted treatments.

A. Medications

  • Cholinesterase inhibitors: These medications, such as Rivastigmine, Donepezil, and Galantamine, work by increasing the levels of chemical messengers in the brain (neurotransmitters) believed to be important for memory, thought, and judgment. This can help improve alertness and cognition and might reduce hallucinations and other behavioral problems.
  • Parkinson’s disease medications: These medications, such as Carbidopa-levodopa can help reduce Parkinsonian signs and symptoms, such as rigid muscles and slow movement.
  • Medications to treat other symptoms: The doctor might prescribe medications to treat other signs and symptoms associated with Lewy body dementia, such as sleep or movement problems.

B. Therapies

Because antipsychotic drugs can worsen Lewy body dementia symptoms, it might be helpful to first try non-drug approaches, such as:

  • Tolerating the behavior: Some people with Lewy body dementia aren’t distressed by the hallucinations. In some cases, the side effects of medication might be worse than the hallucinations themselves.
  • Modifying the environment: Reducing clutter and noise can make it easier for someone with dementia to function.
  • Avoid correcting and quizzing a person with dementia.
  • Offer reassurance and validation of his or her concerns.
  • Creating daily routines and keeping tasks simple.
  • Break tasks into easier steps and focus on successes, not failures.
  • Speak clearly and simply to an individual with Lewy Body Dementia. Maintain eye contact and speak slowly, in simple sentences, and don’t rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
  • Encourage exercise. Benefits of exercise include improvements in physical function, behavior, and depression.
  • Provide mind stimulation. Participating in games, crossword puzzles, and other activities that involve thinking skills might help slow mental decline in people with dementia. Encourage artistic and creative activities, such as painting, singing, or making music.
  • Create opportunities for social activity. Talk to friends and participate in services.

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