Summary about Disease
Lewy body dementia (LBD) is a progressive neurodegenerative disease that involves abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain that control thinking, movement, behavior, and mood. LBD encompasses two related conditions: dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). The main difference is the timing of cognitive and motor symptoms.
Symptoms
Symptoms of LBD can vary widely from person to person but commonly include:
Cognitive: Fluctuating cognition (periods of alertness and confusion), visual hallucinations, problems with attention and executive function (planning, problem-solving).
Motor: Parkinsonian symptoms like rigidity, slow movement (bradykinesia), tremor, and postural instability.
REM Sleep Behavior Disorder (RBD): Acting out dreams during sleep (e.g., yelling, kicking).
Autonomic Dysfunction: Problems with blood pressure regulation, body temperature, bowel and bladder control, and sweating.
Behavioral/Psychiatric: Depression, anxiety, apathy, delusions.
Causes
The exact cause of LBD is unknown. However, it's believed to be related to the abnormal buildup of alpha-synuclein protein into Lewy bodies within nerve cells in the brain. Risk factors are not well-defined, but genetics may play a role in some cases, although LBD is usually not directly inherited.
Medicine Used
There is no cure for LBD, and treatment focuses on managing symptoms:
Cholinesterase inhibitors (e.g., rivastigmine, donepezil): May help with cognitive symptoms and hallucinations.
Levodopa/carbidopa: Can improve motor symptoms (similar to Parkinson's disease treatment), but can sometimes worsen hallucinations or confusion.
Melatonin or clonazepam: For REM sleep behavior disorder.
Antidepressants (SSRIs): For depression and anxiety.
Antipsychotics: Used cautiously to manage hallucinations or delusions, as people with LBD are very sensitive to their side effects.
Medications to manage autonomic dysfunction: such as midodrine for low blood pressure.
Is Communicable
No, Lewy body dementia is not communicable. It is not contagious and cannot be spread from person to person.
Precautions
While LBD isn't preventable, precautions can be taken to manage the condition and improve quality of life:
Safety: Modify the home environment to prevent falls (remove tripping hazards, install grab bars).
Medication Management: Work closely with a doctor to monitor medications and minimize side effects.
Support: Seek support from family, friends, support groups, and healthcare professionals.
Physical Activity: Regular exercise can help with motor symptoms and overall well-being.
Cognitive Stimulation: Engage in activities that challenge the brain, such as puzzles, reading, and social interaction.
Good Sleep Hygiene: Maintaining a regular sleep schedule can help with sleep disturbances.
How long does an outbreak last?
LBD is not an "outbreak" illness. It is a chronic, progressive condition, meaning it worsens over time. There isn't a specific "outbreak" period. The disease progresses gradually, with symptoms evolving over years.
How is it diagnosed?
Diagnosis of LBD can be challenging and often involves:
Medical History and Neurological Examination: Assessment of symptoms, medical history, and a thorough neurological exam.
Cognitive Testing: Tests to evaluate memory, attention, language, and executive function.
Neuroimaging: MRI or CT scans to rule out other conditions and look for brain changes. DaTscan can help differentiate LBD from Alzheimer's.
Sleep Study (Polysomnography): To assess for REM sleep behavior disorder.
Cardiac Scintigraphy (MIBG scan): To assess cardiac sympathetic innervation.
Clinical Criteria: The diagnosis is based on established clinical criteria that consider the core features and supportive features of LBD.
Blood Tests: To rule out other possible causes of dementia
Timeline of Symptoms
The timeline of LBD symptoms varies significantly from person to person. However, a general progression can be described:
Early Stages: Subtle cognitive changes, visual hallucinations, REM sleep behavior disorder, and/or motor symptoms may appear. Fluctuating cognition is often present.
Middle Stages: Cognitive and motor symptoms become more prominent. Difficulties with balance, falls, and autonomic dysfunction may increase. Behavioral symptoms can become more challenging.
Late Stages: Significant cognitive decline, severe motor impairment, and increased dependence on caregivers. Difficulties with swallowing and communication are common. The average survival time after diagnosis is approximately 5-8 years, but this can vary.
Important Considerations
Sensitivity to Neuroleptics: Individuals with LBD are very sensitive to the side effects of antipsychotic medications. These drugs can cause severe rigidity, immobility, and even death. Therefore, they should be used with extreme caution and only when absolutely necessary.
Differential Diagnosis: LBD can be difficult to distinguish from Alzheimer's disease and Parkinson's disease, especially in the early stages. Accurate diagnosis is crucial for appropriate management.
Caregiver Support: LBD can be very challenging for caregivers. Respite care, support groups, and counseling can be invaluable.
Advance Care Planning: Discussing end-of-life wishes and advance care planning is important to ensure the person's preferences are honored.
Research Participation: Participating in research studies can help advance understanding of LBD and develop new treatments.