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List of All Topics
Lewy Body Dementia
Introduction
Lewy body dementia shares characteristics with both Alzheimer's disease and Parkinson's disease. Like Alzheimer's, it causes confusion. It may also cause distinctive physical signs typical of Parkinson's — rigid muscles, slowed movement and tremors. Lewy body dementia can also cause hallucinations.
Dementia is a slowly progressive brain disorder characterized by the loss of ability to think, reason and remember. In Lewy body dementia, abnormal round structures — called Lewy bodies — develop in regions of your brain involved in thinking and movement.
There's no cure for Lewy body dementia— although some people with this disease benefit from drugs developed for Alzheimer's disease. Treatment focuses on managing the signs and symptoms.
It's important that your doctor distinguishes Lewy body dementia from other forms of dementia in creating a treatment plan. This is because some medications used to treat psychiatric symptoms may actually worsen Lewy body symptoms such as hallucinations and delusions.
Signs and symptoms
Visual hallucinations, such as seeing colors, shapes, animals or people, may be one of the first symptoms of Lewy body dementia. Other signs and symptoms are similar to those of both Parkinson's disease and Alzheimer's disease.
Parkinson's-like signs
These may include:
- Slowed movement.
- Rigid muscles.
- Tremors.
- Shuffling walk.
Such symptoms could include:
- Confusion.
- Memory loss.
- Decreased or irregular awareness or reasoning (cognition).
- Delusions such as false ideas about another person or situation.
- Depression.
Another indicator of Lewy body dementia may be a strong reaction — such as worsening delusions and hallucinations — to the medications normally used to treat those symptoms. The reaction to these medications can be debilitating and even life-threatening in those who have this disease, for example causing muscle rigidity, loss of cognition or even catatonia — a condition of either motionless apathy or constant excitement.
Still other signs include REM sleep behavior disorder — which involves acting out your dreams — and signs of dysfunction of the autonomic nervous system, which regulates involuntary muscle movements. Dysfunction of the autonomic nervous system can result in poorly regulated blood pressure, sweating and body temperature.
Causes
The cause of Lewy body dementia isn't known. However, Lewy bodies contain a protein associated with Parkinson's. In addition, Lewy bodies often are found in the brains of people who have Parkinson's or Alzheimer's. This suggests that the three conditions are related or that Lewy body dementia and Alzheimer's or Parkinson's disease sometimes coexist in the same person.
Treatment
Treatment can be challenging, and there's no cure for Lewy body dementia. Instead, doctors treat the individual symptoms.
Medications
- Cholinesterase inhibitors. These Alzheimer's disease medications work by improving the levels of neurotransmitters — chemical messengers believed to be important for memory, thought and judgment — in the brain. They improve alertness and cognition and may reduce hallucinations and other behavioral problems.
- Parkinson's disease medications. These medications can help reduce Parkinson's-like motor symptoms in some people with Lewy body dementia, but they can also cause increased confusion, hallucinations and delusions.
- Antidepressants and anticonvulsants. Some antidepressants, particularly selective serotonin reuptake inhibitors, and anticonvulsants may help improve sleep and reduce anxiety, agitation and depression, but they can also increase problems with confusion, movement and sleepiness.
- Antipsychotic medications. These medications may somewhat improve delusions and hallucinations. However, they can cause problems with sleepiness, memory and cognition and increase the risk of death.
In some cases, medications may not be necessary. For example, reducing impersonal approaches to daily tasks — such as by sponge bathing a person in bed versus giving them a bath or shower — may help reduce agitation and aggression.
Other strategies that have somewhat improved symptoms such as agitation and restlessness include physical therapy, massage, aromatherapy (using fragrant plant oils for relaxation), music therapy and pet therapy.
Problems with sleeping may improve with increased activity, reducing daily naps and caffeine intake, and delaying bedtime.
Caregiving
Until there's a cure for Lewy body dementia, people with the disease will require care. Caregiving can be a challenge. The unpredictable decline that may last more than a decade requires caregivers to exercise patience, understanding, compassion, and often, creativity.
The key to caregiving is focusing on things that the person with dementia can still do and enjoy. In fact, learning ways to reduce the impact of impaired abilities and behavior problems can help avoid some of the most difficult aspects of the disease.
Each person with dementia experiences symptoms and progression differently. Consequently, the techniques to care for each person should vary. You may have to adapt the following tips to your specific caregiving situation:
- Use memory aids. Memory aids may help a friend or family member remain independent. Write out a list of the day's activities, the phone numbers that can be used to call for help, and instructions on how to do simple tasks, such as making a cup of tea or using the telephone.
- Provide structure. A home environment that provides serenity and stability reduces behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do a task that's too difficult can cause anxiety. As a person becomes upset, the ability to think clearly declines even more.
- Monitor wandering. Wandering is a common problem. In some cases, a pocket card with simple instructions, such as "Call home" (with a phone number below), may help. Make sure your loved one wears a bracelet with his or her name, phone number and a notation such as "Memory impaired." The Alzheimer's Association, which has a 24-hour hot line — 800-272-3900 — offers this resource through its national Safe Return Program.
Also try to determine the cause of wandering. It may simply be a signal that the person with dementia is looking for something, such as a bathroom, or is seeking a meaningful activity or reassurance. Some experts believe taking your loved one for a vigorous daily walk helps reduce wandering. - Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation. Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.
- Enhance communication. When talking with your loved one, stand where you can be seen and touch his or her arm or shoulder to focus attention. 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. Avoid asking questions or offering difficult choices because trying to come up with answers may prove frustrating.
- Create a safe environment. Make your home familiar and safe. Keep furniture in the same place to avoid clutter and help prevent falls. Install locks on cabinets containing medicines, alcohol, guns, toxic substances, and dangerous utensils and tools. Remove electrical appliances from your bathroom to prevent shocks, set your water heater no higher than 120 F to prevent scalding, and install grab rails to prevent falls.
- Encourage exercise. Exercise carries many benefits. The fact that these benefits often are the same for people without dementia doesn't lessen their importance. In fact, it just makes exercise a more important activity for caregivers and people with dementia to engage in together. The main benefits of exercise include improved strength and cardiovascular health. Exercise can also lessen symptoms of depression, help retain motor skills and create a calming effect. It can also help sustain strength, flexibility and balance — which may lessen the risk of serious injury from a fall.
In addition to helping a loved one with Lewy body dementia deal with daily challenges, you'll need to begin to try to answer practical, long-term questions about caregiving as soon as possible. These questions may involve personal, legal and financial issues. Some examples might include:
- Level of self-sufficiency. How long can a person with dementia safely drive, work or live alone?
- Availability of help. Can family or friends provide the care necessary for the current phase and during later progression of the disease?
- Financial resources. Is money available for professional in-home care or a care facility now or in the future if the need arises?
Information obtained from National Institute of Health