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What Is Lewy Body Dementia? Symptoms and Causes.

Lewy body dementia, alternatively referred to as Dementia with Lewy bodies, is the second most common type of progressive dementia, behind Alzheimer's disease. Lewy bodies are protein deposits that accumulate in nerve cells in parts of the brain that are critical for thought, memory, and movement (motor control). 


Lewy body dementia is characterized by a progressive deterioration of mental functions. Visual hallucinations and disturbances in alertness and attention may occur in people with Lewy body dementia. Other complications include indications and symptoms of Parkinson's disease such as tight muscles, slow movement, difficulty walking, and tremors.


Symptoms


Among the indications and symptoms of Lewy body dementia are the following:

Visual hallucinations Hallucinations 

Seeing things that aren't there — is frequently one of the initial symptoms of schizophrenia, and they frequently reoccur. Individuals suffering from Lewy body dementia may experience hallucinations of forms, animals, or humans. Hallucinations of sound (auditory), smell (olfactory), or touch (tactile) are all possible.

Disorders of movement.

Parkinson's disease symptoms (parkinsonian signs) can include delayed movement, tight muscles, tremors, or a shuffling gait. This can result in a fall.

Inadequate control of bodily functioning (autonomic nervous system). The nervous system regulates blood pressure, pulse, perspiration, and the digestive process. This component of the nervous system is frequently damaged by Lewy body dementia. This can result in abrupt reductions in blood pressure when standing (orthostatic hypotension), dizziness, falls, loss of bladder control (urinary incontinence), and bowel problems such as constipation.

Cognitive difficulties. 

You may experience similar cognitive (thinking) impairments to those associated with Alzheimer's disease, such as confusion, poor focus, visual-spatial difficulties, and memory loss.

Sleep disturbances. 

You could be suffering from rapid eye movement (REM) sleep behavior disorder, which causes you to physically act out your dreams while sleeping. This could include punching, kicking, yelling, or screaming while sleeping.

The attention fluctuates. 

Drowsiness, prolonged periods of looking into space, daytime naps, or confused speaking are all possibilities.

Depression.

You may experience depression.

Apathy. 

You may experience a loss of motivation.



Causes


Lewy body dementia is defined by an abnormal accumulation of proteins in the form of Lewy bodies. Additionally, this protein has been linked to Parkinson's disease. Lewy bodies are found in the brains of people who also have the plaques and tangles associated with Alzheimer's disease.

Risk Factors

Several factors, including the following, appear to enhance the likelihood of developing Lewy body dementia:

Age. Individuals above the age of 60 are at an increased risk.
Sex. Men are more likely to get Lewy body dementia than women.
Ancestral history. Individuals with a family member who suffers from Lewy body dementia or Parkinson's disease are at an increased risk.


Complications

Dementia with Lewy bodies is progressive. Signs and symptoms deteriorate, resulting in:
Severe dementia
Aggressive behavior
Depression
The risk of falling and injury increased
Symptoms and indicators of parkinsonism, such as tremors, deteriorate
Death occurs, on average, approximately seven to eight years following the onset of symptoms.


Diagnosis


Progressive deterioration in your ability to reason is required for a diagnosis of Lewy body dementia, as are at least two of the following:

Fluctuating alertness and cognitive function
Visual hallucinations that occur repeatedly
Symptoms of Parkinson's disease
REM sleep behavior disorder, a condition in which individuals act out their dreams while sleeping

Autonomic dysfunction, which manifests as fluctuations in blood pressure and heart rate, inability to regulate body temperature, excessive perspiration, and other signs and symptoms, supports a diagnosis of Lewy body dementia. Additionally, sensitivity to antipsychotic medications, particularly first-generation antipsychotics like haloperidol, increases (Haldol). Due to the possibility of a severe reaction, medications such as Haldol are not recommended for persons with Lewy body dementia.

There is no single test that can accurately diagnose Lewy body dementia. The diagnosis is made based on your indications and symptoms and the exclusion of other possible causes of comparable signs and symptoms. Tests may include the following:

Physical and neurological examinations


Your doctor may examine you for symptoms of Parkinson's disease, strokes, tumors, or other medical illnesses that can impair your brain and physical function. Examination of the nervous system:

Reflexes 
Walking
Tone of muscles
Strength 
Balance 
Touch Sensation

Mental capabilities evaluation


This exam, which evaluates your memory and reasoning abilities, can be completed in less than ten minutes in your doctor's office. It is not beneficial in separating Lewy body dementia from Alzheimer's disease in general but can indicate the presence of cognitive impairment. Prolonged tests lasting several hours aid in the diagnosis of Lewy body dementia.


Blood tests


These tests can help rule out medical conditions that could impair brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.

CT images of the brain


Your doctor may conduct an MRI or CT scan to rule out a stroke or hemorrhage and to rule out the presence of a tumor. While dementias are diagnosed primarily on a patient's medical history and physical examination, some imaging findings may indicate the presence of specific forms of dementia, such as Alzheimer's or Lewy body dementia.

If the diagnosis is uncertain or if the signs and symptoms are not typical, your doctor may advise additional imaging tests, such as the following that can help confirm a diagnosis of Lewy body dementia:

Fluorodeoxyglucose PET brain scans are used to determine the function of the brain.
PET or single-photon emission computed tomography (SPECT) imaging can be used to evaluate if dopamine transporter uptake is decreased in the brain.

Sleep assessment

Your doctor may prescribe a polysomnogram to check for evidence of REM sleep behavior disorder or an autonomic function test to check for signs of heart rate and blood pressure instability.

Examination of the heart


In some countries, doctors may also perform a heart scan called myocardial scintigraphy to check for signs of Lewy body dementia. In the United States, however, the test is not used.

Emerging biomarkers


Additional markers of Lewy body dementia are being investigated. These biomarkers may one day enable the early detection of Lewy body dementia before the disease progresses to its full extent.



Treatment


Although Lewy body dementia has no cure, many of the symptoms can be improved with targeted treatments.

Medications


Cholinesterase inhibitors

These drugs for Alzheimer's disease, such as rivastigmine (Exelon), donepezil (Aricept), and galantamine (Razadyne), act by raising the amounts of chemical messengers in the brain (neurotransmitters) known to be involved in memory, cognition, and judgment. This can aid in the improvement of alertness and cognition, as well as the reduction of hallucinations and other behavioral issues.

Constipation, muscle cramps, and frequent urination are all possible side effects. Additionally, it may raise the risk of developing certain heart arrhythmias.

The combination of a cholinesterase inhibitor with an N-methyl-d-aspartate (NMDA) receptor antagonist, such as memantine, may be beneficial in certain people with moderate or severe Alzheimer's disease (Namenda).


Medications for Parkinson's disease. 

These drugs, which include carbidopa-levodopa (Sinemet, Rytary, and Duopa), can help alleviate parkinsonian signs and symptoms such as tight muscles and delayed movement. These drugs, however, can aggravate confusion, hallucinations, and delusions.

Medications to treat further symptoms. 

Other indications and symptoms of Lewy body dementia, including sleep or mobility issues, may be treated with medication.
Certain drugs have been shown to impair memory. Avoid sleeping pills containing diphenhydramine (Advil PM, Aleve PM) and drugs intended to alleviate urine urgency, such as oxybutynin (Ditropan XL).

Additionally, avoid sedatives and sleeping pills and speak with your doctor about if any of the medications you take may impair your memory.

Antipsychotic medications can result in severe disorientation, parkinsonism, drowsiness, and occasionally death. Quetiapine (Seroquel) and clozapine (Clozaril, Versacloz) are two examples of second-generation antipsychotics that may be prescribed for a short time at a low dose only when the benefits outweigh the risks.

Therapies

In light of the fact that antipsychotic medicines might increase the symptoms of Lewy body dementia, it may be beneficial to initially attempt nondrug treatments such as:

Accepting and tolerating the behavior. Some patients with Lewy body dementia are not bothered by the hallucinations, despite the fact that others are. In certain instances, the side effects of the medicine may even be more distressing than the hallucinations they are intended to treat.

Changing the environment is a good thing. It may be simpler for someone suffering from dementia to function if they have less clutter and noise around them. The responses of caregivers might sometimes complicate the problem.

Avoid correcting and quizzing someone who is suffering from dementia. Provide reassurance and acknowledgment of his or her fears, if possible.

Developing regular routines and keeping chores simple is important. Tasks should be broken down into smaller parts, and successes should be celebrated rather than failures. When there is structure and routine throughout the day, it might be less perplexing. The combination of a cholinesterase inhibitor with an N-methyl-d-aspartate (NMDA) receptor antagonist, such as memantine, may be beneficial in certain people with moderate or severe Alzheimer's disease (Namenda).


Lifestyle and home remedies


Everyone with Lewy body dementia experiences a unique set of symptoms and progression. Caregivers and care partners may need to tailor the following suggestions to their specific circumstances:

Communicate in a straightforward and concise manner. 

Keep a steady gaze on the other person and use short, uncomplicated statements to avoid sounding hurried. Only one notion or instruction should be presented at a time. Make use of hand gestures and clues, such as pointing to objects, to communicate.

Encourage people to get active. 

Exercise has a variety of health benefits, including improvements in physical function, behavior, and depression. According to some research, exercise may be beneficial in slowing cognitive deterioration in patients suffering from dementia.

Stimulate the mind. 

Participating in games, crossword puzzles, and other activities that require thinking abilities may assist persons with dementia to reduce their mental deterioration. Promote artistic and creative endeavors such as painting, singing, and music production. Provide possibilities for social interaction. Consult your buddies. Take an active role in religious services.

Create bedtime rituals.

At night, behavioral disorders can deteriorate. Establish soothing nighttime rituals free of distractions such as television, dinner preparation, and busy family members. Keep night lights on to avoid being disoriented.

Caffeine restriction during the day, discouragement of daytime napping, and provision of opportunities for daily activity may all contribute to preventing nighttime restlessness.

Alternative medicine

Frustration and worry can intensify the symptoms of dementia. Consider the following to aid with relaxation:

Music therapy is a technique that entails listening to relaxing music.
Pet therapy, which entails the use of animals to help persons with dementia improve their attitudes and behaviors
Aromatherapy is a form of therapy that makes use of fragrant plant oils.
Massage treatment

Coping and assistance


Individuals suffering from Lewy body dementia frequently experience a range of feelings, including confusion, frustration, anger, fear, uncertainty, grief, and depression. Provide support by listening, reminding the individual that he or she can still enjoy life, being optimistic, and doing your best to assist the individual in regaining dignity and self-respect.

If you're a caretaker or care partner for someone who has Lewy body dementia, keep a tight eye on him or her to ensure they don't fall, lose consciousness, or have bad effects on drugs. Assure anyone experiencing disorientation, delusions, or hallucinations.

Lewy body dementia - Symptoms and causes
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