Dementia with Lewy Bodies

From the National Parkinson Foundation and the Institute for Aging & Health

Dementia is a general term for an illness that has caused a patient to become progressively and irreversibly confused. Although the earliest symptoms may vary from patient to patient, depending on the cause of the dementia, in most cases the patients experience impairment of memory and changes in their communication skills, personality, decision-making, problem solving and other aspects of their cognitive functioning. The most common of the incurable dementias is Alzheimer's Disease (AD). The second most common dementia shares some features with Parkinson's disease (PD) and is called "Dementia with Lewy Bodies" (DLB)

> DLB is named for the abnormal protein collections called Lewy bodies that accumulate within the brain cells. Lewy bodies are found in the brain cells of the cerebral cortex (the primary "thinking" area of the brain), and are found in both DLB and in PD and are presumably related to the cause of the nervous system dysfunction in both diseases.

> The three main symptoms of Dementia with Lewy Bodies are:

1) Fluctuating alertness and/or cognition. At times, the person with DLB will be alert and then suddenly have acute episodes of confusion. These episodes may last hours or days. Because of these fluctuations, it is not uncommon for caregivers to think that the person is "faking" or attempting to get attention.

2) Recurrent visual hallucinations. 80% of DLB patients experience neuropsychiatric symptoms, including hallucinations, delusions, apathy, anxiety, depression and sleep disturbance. Hallucinations are usually, but not always, visual and often are more pronounced when the person is most confused. The hallucinations are not necessarily frightening to the person, but are very disturbing to the caregivers. These hallucinations are vivid to the patient and usually involve seeing people or animals that are not real.

3) Physical symptoms of Parkinson's Disease (PD) such as changes in gait. The patient may shuffle or walk stiffly. Frequent falls are also common occurrences. Some patients experience fainting or dizzy spells, disordered sleep and alterations of consciousness.

Two of the above symptoms, along with signs of dementia, result in a probable diagnosis of Lewy Body Disease. One of these symptoms plus signs of dementia results in a possible diagnosis.

Because some patients with DLB may have only minor problems with the classic DLB symptoms, they may appear very similar to patients with AD. In fact, a critical current research issue is how to distinguish those with DLB from those with AD early in the course of the disease. Patients with DLB are much more sensitive to the pharmacological interventions that are typically used in patients with AD. Some treatments for hallucinations and delusion in DLB patients can increase rigidity, immobility, confusion, sedation and falls. About 50% of treated patients develop severe side effects and it is not possible to predict sensitivity reactions in an individual patient before treatment starts. Serious adverse reactions with tranquilizing medications have been reported by some patients, physicians, and caregivers. Careful consideration should be made while planning medication management for persons suspected of having DLB.

There are also other features of DLB that differ from AD. Some researchers have reported as high as a 2:1 male to female ratio in DLB, in contrast to the well-known female predominance in AD. The average disease duration rate in DLB is five to six years as compared to 8-10 years in AD.

Persons with DLB often experience significant sleep disturbance including moving, gesturing and speaking during sleep. They may appear more confused between the dream and waking reality and take longer to become fully awake.

To conclude, DLB remains challenging to diagnose and treat. It is a degenerative disease that over time causes a patient to become demented. Although similar to AD in some ways, DLB may have a different cause than AD and hence would require a different treatment and cure. Further research is critical to discover ways to diagnose DLB during its early stages and better understand its relationship to Alzheimer's and Parkinson's Disease.

For more information on Lewy Body Disease, see the National Parkinson Foundation website (www.parkinson.org) or the Lewy Body Dementia Association at www.lewybodydementia.org

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