Resembling symptoms caused by Parkinson’s and Alzheimer’s, Lewy body disease (also called “dementia with Lewy bodies”) is an oft-misdiagnosed disease that affects nearly 1.4 million people in the U.S. each year. For this reason, many people have not heard of this type of dementia and even medical professionals remain unfamiliar with the disease.
People with Parkinson’s disease and those who have dementia with specific “Lewy bodies” in the brain can be diagnosed with LBD. Early symptoms of these two diseases do not overlap but represent the same biological changes occuring among normal neuronal connections and chemistry of the brain. One of the unfortunate things about Lewy body disease is that discernible symptoms may not manifest themselves until you have had the disease for two years or more.
Lewy Body Disease Signs
Depending on the cause of the dementia, symptoms and severity of symptoms will differ among people with the disease with LBD. It is possible to score normally on cognitive tests but still meet certain LBD criteria concerning short-term memory loss and attention deficits. In fact, the standardized MMSE (Mini-Mental State Examination) is not considered a reliable tool to use for distinguishing LBD from other dementia types.
By the time Lewy body disease symptoms are apparent, clumps of “Lewy bodies” (named after the physician who discovered them) have formed in brain cells, or neurons. These ubiquitin and alpha-synuclein proteins damaging brain cells are only detectable when a post mortem brain examination is performed.
Similar to Alzheimer’s, the decline of cognitive functioning caused by LBD is due to the reduced activity of cholinergic neurons responsible for releasing acetylcholine. Alternately, problems with motor control, such as walking and initiating movement, are caused by the destruction of dopaminergic neurons, or neurons that release dopamine. People suffering from Parkinson’s disease experience more severe issues with decreased dopamine levels than those with Alzheimer’s.
Core features of Lewy body disease include:
- Fluctuating severity of alertness, attention and basic cognitive skills–a person may seem normal for a few hours and then begin showing signs of vague thinking, memory loss and trouble finishing sentences.
- Recurring visual hallucinations and delusions in nearly 75 percent of those with LBD
- Shuffling instead of walking, blank expression and stiff movements, which are also hallmark features of Parkinson’s disease
- Speaking inaudibly
- Dizziness and fainting
- Problems with swallowing
According to Lewy body dementia information, some people with the disease may experience tremors much like Parkinson’s patients experience, although it is not as common with LBD as it is with Parkinson’s.
What Causes Lewy Body Disease
Although the cause of this dementia is not yet known, LBD is thought to be associated with the PARK11 gene, which may also be promoted by the inheritance of the APOE allele. In addition to the spread of Lewy bodies, the brain also undergoes cerebral atrophy and degeneration of the cerebral cortex. Autopsy research has found that LBD and Alzheimer’s pathology is similar in that they are often co-morbid, or existing together in the brain. While Lewy bodies tend to affect the cortex, the plaques and tangles indicative of Alzheimer’s attack the hippocampal area instead.
Diagnosis and Treatment
Before a diagnosis is made, your doctor will perform complete neurological and physical examinations, discuss whether any history of dementia in your family exists and test your language, memory, attention and visuospatial skills. Brain imaging scans may be ordered and blood tests may be done to determine if any other disorders are affecting your health.
Like Alzheimer’s disease, LBD has no cure but medications and holistic treatment plans offer palliative management of symptoms. The problem with LBD is that medications designed to relief stiff muscles and tremors may worsen delusional thinking as well as hallucinations, and vice versa. Alzheimer’s medications such as Aricept and Excelon (both cholinesterase inhibitors) seem to work well in slowing the decline of cognitive problems. Clonazepam is prescribed for sleep disorders and methylphenidate enhances alertness in some LBD patients.
Antipsychotics are used as a last resort to control delusions and hallucinations because of the adverse and often long-term side effects caused by these drugs.
The highest risk factor promoting the development of LBD is age, with people over 65 typically showing signs of the disease. More men than women are affected by LBD and lifestyle may have some bearing on whether the disease can be delayed or symptom severity can be reduced. As with Alzheimer’s disease, clinical studies indicate that getting regular exercise, eating healthy foods, and engaging in mentally stimulating activities might delay the onset of this dementia as well as other dementia types.
The average duration of Lewy body disease is around five to seven years. However, this number depends on several factors influencing a person’s health at the time of diagnosis, such as overall health, genetics, and age. Caring for someone in the advanced stages of LBD can be difficult and heartbreaking but support groups, local agencies on aging and home healthcare nurses are available to help those who are involved with a family member suffering from LBD.