Summary about Disease
Dementia with Lewy bodies (DLB) is a type of dementia characterized by abnormal deposits of alpha-synuclein protein, called Lewy bodies, in the brain. These deposits disrupt the brain's normal function, leading to a decline in thinking, movement, behavior, and mood. DLB is progressive, meaning the symptoms worsen over time. It shares similarities with both Alzheimer's disease and Parkinson's disease, making diagnosis challenging.
Symptoms
The symptoms of DLB can vary significantly from person to person, but core features include:
Fluctuating cognition: Variations in attention and alertness that can change dramatically over hours or days.
Visual hallucinations: Seeing things that are not there. These are usually well-formed and detailed.
Parkinsonism: Movement symptoms similar to Parkinson's disease, such as slow movement (bradykinesia), rigidity, tremor, and postural instability.
REM sleep behavior disorder (RBD): Acting out dreams, often violently, during REM sleep.
Other symptoms may include depression, anxiety, apathy, delusions, and problems with autonomic functions (blood pressure, bowel control, etc.).
Causes
The exact cause of DLB is unknown, but it is associated with the accumulation of Lewy bodies in the brain. Lewy bodies are made of a protein called alpha-synuclein. What triggers the formation of these abnormal deposits is not fully understood. Genetics may play a role in some cases, but most instances of DLB appear to occur sporadically.
Medicine Used
There is no cure for DLB, but medications can help manage some of the symptoms:
Cholinesterase inhibitors (e.g., donepezil, rivastigmine): May improve cognitive symptoms and hallucinations.
Levodopa: Can help with parkinsonian symptoms, but can also worsen hallucinations or confusion in some individuals.
Melatonin or clonazepam: Used to treat REM sleep behavior disorder.
Antidepressants (SSRIs): Used to treat depression and anxiety.
Antipsychotics: Used with extreme caution to treat hallucinations and delusions, as people with DLB are highly sensitive to their side effects. Newer atypical antipsychotics, used at very low doses, may be necessary in some cases, but careful monitoring is required.
Is Communicable
DLB is not communicable. It is not an infectious disease and cannot be spread from one person to another.
Precautions
Since DLB is not communicable, there are no precautions to prevent catching it. However, general safety measures are important for individuals with DLB:
Fall prevention: Modify the home to reduce fall risks (remove clutter, install grab bars).
Medication management: Ensure medications are taken correctly and monitored for side effects.
Cognitive and physical therapy: Can help maintain function and independence.
Support groups: Connecting with others affected by DLB can provide emotional support and practical advice for patients and caregivers.
How long does an outbreak last?
DLB is not an outbreak. It is a chronic, progressive neurological disorder, meaning it gets worse over time. The duration of the disease varies but is typically 5-8 years after diagnosis.
How is it diagnosed?
Diagnosing DLB can be challenging, as its symptoms overlap with other conditions. Diagnosis typically involves:
Neurological examination: Assessment of motor skills, reflexes, and sensory functions.
Cognitive testing: Evaluating memory, attention, language, and other cognitive abilities.
Neuropsychological testing: More detailed assessment of cognitive functions.
Brain imaging (MRI or CT scan): To rule out other causes of dementia, such as stroke or tumor.
DaTscan: A nuclear medicine imaging test that can help differentiate DLB from Alzheimer's disease by assessing dopamine transporter function in the brain.
Sleep study (polysomnography): To detect REM sleep behavior disorder.
Cardiac MIBG scan: Another nuclear medicine imaging test, this one showing problems in the autonomic nervous system that can occur in DLB.
Clinical criteria: Doctors use specific diagnostic criteria, such as the McKeith criteria, to help determine the likelihood of DLB. These criteria consider the core and supportive features of the disease.
Timeline of Symptoms
The timeline of DLB symptoms varies from person to person, but the disease generally progresses gradually over several years.
Early stages: Symptoms may be mild and intermittent. Fluctuations in cognition, visual hallucinations, and/or movement problems may be the first signs. REM sleep behavior disorder may precede other symptoms by years.
Middle stages: Cognitive and motor symptoms become more pronounced and consistent. Problems with memory, attention, and executive function worsen. Parkinsonian symptoms become more apparent. Hallucinations and delusions may become more frequent and distressing.
Late stages: Severe cognitive impairment, significant motor disability, and behavioral disturbances are common. Individuals may require assistance with all aspects of daily living.
Important Considerations
Accurate diagnosis: It is crucial to seek expert diagnosis as early as possible. This allows for appropriate management and support.
Sensitivity to medications: Individuals with DLB are highly sensitive to certain medications, particularly antipsychotics. Careful medication management is essential.
Caregiver support: DLB is a challenging disease for both patients and caregivers. Caregivers need ongoing support, education, and resources to cope with the demands of caregiving.
Advance care planning: Discussing end-of-life wishes and making plans for future care is important.
Research participation: Consider participating in clinical trials or research studies to help advance our understanding of DLB and develop new treatments.