Lewy Body Dimentia (LBD) is a progressive degenerative disease or syndrome of the brain. It shares symptoms,and sometimes overlaps, with several diseases, especially Alzheimer’s and Parkinson’s.
Lewy bodies were first described in the early 20th century by Dr Friedrich Lewy, who was studying the brains of people with Parkinson’s disease, a condition recognised by a combination of a shaking tremor, slowness of limb movements, and a shuffling walk.
Lewy bodies are, in fact, microscopic clumps of a protein called alpha-synuclein which may, under certain and as yet not understood circumstances, accumulate within nerve cells in the brain. When some critical brainstem and midbrain structures including the substantia nigra are involved, there is a loss of the neurotransmitter dopamine and Parkinson’s disease is the result.
LBD can take two forms: dementia with Lewy bodies or Parkinson’s disease dementia. The difference between them lies mainly in how the disease starts. In dementia with Lewy bodies, the person may have a memory disorder that looks like Alzheimer’s but later develop movement and other distinctive problems, such as hallucinations. In Parkinson’s disease dementia, the person may initially have a movement disorder that looks like Parkinson’s but later also develop dementia symptoms. Over time, though, both diagnoses will appear the same. Most people with LBD develop a similar spectrum of problems that include variations in attention and alertness, recurrent visual hallucinations, shuffling gait, tremors, and blank expression, along with various sleep disorders.
Other names for Lewy body dementia include –
- Diffuse Lewy body disease
- Cortical Lewy body disease
- Lewy body disease
- Senile Dementia of Lewy Type
- Dementia with Lewy bodies
- Lewy body variant of Alzheimer’s disease
While Lewy Body Dementia can bear a striking resemblance to Alzheimer’s disease or Parkinson’s disease, treatment can be very different, making early recognition of the signs and symptoms key to managing the condition.
Causes
Lewy body dementia is caused by degeneration or deterioration of brain tissue. Lewy body dementia may be genetic, but it is not always clear why someone develops Lewy body dementia. Lewy bodies in the brain affect substances called neurotransmitters. A neurotransmitter is a chemical that helps to transmit signals from one nerve cell to another.
One type of neurotransmitter is dopamine, which helps transmit signals that cause muscle movement. Lewy bodies interfere with the production of dopamine. A lack of dopamine causes movement problems, such as those seen in Parkinson disease.
Acetylcholine is another type of neurotransmitter found in the parts of the brain responsible for memory, thinking, and processing information. When Lewy bodies build up in these areas, they use up the acetylcholine, causing symptoms of dementia.
Risk Factors
DLB accounts for around 4 per cent of all recorded dementia, but there is good evidence that the condition is under-diagnosed. Based on studies of brain tissue after death, scientists think DLB may represent as much as 10 per cent of all dementia.
DLB appears to affect men and women about equally. As with Alzheimer’s disease and vascular dementia, DLB becomes more common over the age of 65. However, in certain cases people under 65 develop DLB.
Other Factos
- Diseases and health conditions—Certain diseases and health conditions, particularly Parkinson’s disease and REM sleep behavior disorder, are linked to a higher risk of LBD.
- Genetics—While having a family member with LBD may increase a person’s risk, LBD is not normally considered a genetic disease. A small percentage of families with dementia with Lewy bodies has a genetic association, such as a variant of the GBA gene, but in most cases, the cause is unknown. At this time, no genetic test can accurately predict whether someone will develop LBD. Future genetic research may reveal more information about causes and risk.
- Lifestyle—No specific lifestyle factor has been proven to increase one’s risk for LBD. However, some studies suggest that a healthy lifestyle—including regular exercise, mental stimulation, and a healthy diet—might reduce the chance of developing age-associated dementias.
Symptoms
Lewy body dementia has 3 features that distinguish it from other forms of dementia –
- Fluctuating effects on mental functioning, particularly alertness and attention, which may resemble delirium
- Recurrent visual hallucinations
- Parkinson-like movement symptoms, such as rigidity and lack of spontaneous movement
In Lewy body dementia, memory problems often occur later in the progression of the disease.
Lewy body dementia can be confused with other forms of dementia, but it also has unique features, such as hallucinations and delirium.
The primary sign of Lewy body dementia is a progressive decline in cognitive functions, such as memory, thinking, and problem-solving. The decline in cognitive function is enough to affect the ability to work and perform normal daily activities. Although memory may be affected, it isn’t usually as impaired as in someone with Alzheimer disease.
Lewy body dementia is generally diagnosed when at least 2 of the following features are also present with dementia –
- Fluctuations in attention and alertness – These fluctuations may last for hours or days. Signs of these fluctuations include staring into space, lethargy, drowsiness, and disorganized speech. These fluctuations have been referred to as “pseudo delirium” because they are a lot like delirium.
- Visual hallucinations – These hallucinations recur and are very detailed. While the hallucinations may be upsetting to someone observing them, they generally don’t bother the person having them. Many people with Lewy body dementia have detailed visual hallucinations.
- Movement symptoms consistent with Parkinson disease (PD) – Such movement symptoms include slow movement, shuffling gait, rigidity, and falls. Tremors may also be present, but not as pronounced as in a person with PD with dementia.
Additional signs and symptoms seen in Lewy body dementia include –
- Depression
- Sleep disorder that affects REM sleep, causing vivid dreams with body movement
- Dizziness, feeling lightheaded, fainting, or falling
- Urinary incontinence
The symptoms of Lewy body dementia may resemble other conditions. Always see a health care provider for a diagnosis.
Complications
Lewy body dementia is progressive. Signs and symptoms worsen, causing –
- Severe dementia
- Death, on average about eight years after onset of the condition
Treatment
Medications
- Cholinesterase inhibitors – These Alzheimer’s disease medications, such as rivastigmine (Exelon), work by increasing the levels of chemical messengers believed to be important for memory, thought and judgment (neurotransmitters) in the brain.
- Parkinson’s disease medications – These medications — such as carbidopa-levodopa (Sinemet) can help reduce parkinsonian symptoms, such as rigid muscles and slow movement — in some people with Lewy body dementia. However, these medications may also cause increased confusion, hallucinations and delusions.
- Antipsychotic medications – These medications, such as quetiapine (Seroquel), olanzapine (Zyprexa) and others, may somewhat improve delusions and hallucinations. However, some people with Lewy body dementia have a dangerous sensitivity to some of these drugs. Reactions, which are sometimes irreversible, can include severe parkinsonian symptoms and confusion.
- Medications to treat symptoms – The doctor may prescribe medications to treat other symptoms associated with Lewy body dementia, such as sleep or movement problems.
Complementary Treatment
- Physical therapists can help with movement problems through cardiovascular, strengthening, and flexibility exercises, as well as gait training and general physical fitness programs.
- Speech therapists may help with low voice volume, voice projection, and swallowing difficulties.
- Occupational therapists help identify ways to more easily carry out everyday activities, such as eating and bathing, to promote independence.
- Music or expressive arts therapists may provide meaningful activities that can reduce anxiety and improve well-being.
- Mental health counselors can help people with LBD and their families learn how to manage difficult emotions and behaviors and plan for the future.
- Aromatherapy is largely used in cases of dementia. These effects from the smells influence the outcomes in treatments.
- Recreational Therapy – These programs include things such as exercise and movement groups, pet therapy, cognitive fitness which includes things such as playing trivia and word type games.
- Exercise – Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety.
- Massage – Massage therapy can reduce muscle tension and promote relaxation. These services, however, are rarely covered by health insurance.
- Acupuncture – During an acupuncture session, a trained practitioner inserts tiny needles into many specific points on the body, which may reduce the pain.
- Tai chi – An ancient form of Chinese exercise, tai chi employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.
- Yoga – In yoga, gentle stretching movements and poses may increase theflexibility and balance.
- Alexander technique – This technique — which focuses on muscle posture, balance and thinking about how you use muscles — may reduce muscle tension and pain.
- Meditation – In meditation, body quietly reflects and focuses on mind, on an idea or image. Meditation may reduce stress and pain and improve the sense of well-being.
Alternative Treatment
Chiropractic – Upper cervical chiropractic care has been noted in some cases to have success on the outcome of Parkinson’s disease. It had shown improvements in such areas of spinal pain, posture, improvement in fluid walking, facial expression and reduced tremors. Since treatments of this disease are used for those of Alzheimer’s and Parkinson’s it could help improve symptoms. However, there have been no scientific studies done on this concept.
Vitamin E – Vitamin E can fight damage in the brain caused by free radicals, and has been suggested to lower the risk of LBD. But taking vitamin E alone did not seem to have the same effect. More studies are needed to know whether there is any real benefit. Vitamin E supplements can increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Selenium is an antioxidant that works with vitamin E. It also helps to increase circulation and tissue oxygenation, thereby limiting damage to nerve cells.
Gamma-aminobutyric acid (GABA) is an amino acid that acts as a neurotransmitter. It helps both to strengthen and relax the nervous system.
Acidophilus and bifidobacteria are friendly bacteria that ensure a healthy gastrointestinal tract. Probiotics are especially helpful for preventing constipation, which is often a problem for people with Parkinson’s disease.
Alpha-lipoic acid is an antioxidant that also helps to “recharge” other antioxidants in the body.
Calcium and magnesium are imperative for maintaining a healthy nervous system.
Coenzyme Q10 is an oxygenating antioxidant that helps prevent free-radical damage and important for cell renewal.
Evening primrose oil and flaxseed oil contain valuable essential fatty acids (EFAs), which are often deficient in people with LBD.
Green-foods supplements supply chlorophyll and important trace minerals.
Marine alginate concentrate and N-acetylcysteine may help in the process of chelating (binding to) heavy metals in the body so that they can be excreted.
Nicotinamide adenine dinucleotide hydrogren (NADH) is an enzyme that helps to improve neurotransmitter function.
Phosphatidylserine is a type of lipid important for normal brain function and the effective transmission of nerve impulses. Low levels of phosphatidylserine are associated with LBD.
Soy Lecithin is rich in phosphatidylcholine. Choline is a vital building block for acetylcholine.
Pine-bark and grape-seed extracts fight free-radical damage and have anti-inflammatory properties. Many people consider Parkinson’s disease to be a consequence of degeneration of nerve cells due to free-radical damage.
The B vitamins are very important for brain and nerve function.
Vitamin C and the bioflavonoids are powerful antioxidants that fight free radicals.
Creatine – Some studies suggest that taking creatine, an amino acid that helps supply energy to muscles, may help slow progression of Parkinson’s among people who are in the early stages, and who do not need medication to control symptoms.
Reference –
http://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/basics/causes/con-20025038
https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=113
http://www.medicalnewstoday.com/articles/302230.php
http://memory.ucsf.edu/education/diseases/dlb
http://www.nhs.uk/Conditions/dementia-with-lewy-bodies/Pages/Introduction.aspx
https://www.caregiver.org/dementia-lewy-bodies
http://www.alzheimer.ca/en/About-dementia/Dementias/Lewy-Body-Dementia
https://fightdementia.org.au/about-dementia/types-of-dementia/lewy-body-disease
http://www.alz.org/dementia/dementia-with-lewy-bodies-symptoms.asp
http://www.acupuncturetoday.com/mpacms/at/article.php?id=28184