Lewy body dementia (LBD) affects more than one million people in the United States, making it one of the most widespread neurological disorders. LBD typically affects people aged 50 or older, although some younger people also exhibit the symptoms of this disorder.
Lewy body dementia seems to affect men slightly more than women and is dotted with symptoms similar to Alzheimer’s disease – forgetfulness, cognitive decline, and unpredictability. If you or any of your loved ones has recently been diagnosed with this disorder, you may be thinking about what to expect as the disease progresses.
This article delves into the intricacies of this disease, highlights Lewy body dementia stages, what causes Lewy body dementia, and how it can be treated. Let’s get into it!
What is Lewy Body Dementia?
Lewy body dementia is a neurological disease typically associated with an abnormal build-up of a protein called alpha-synuclein in the brain. These abnormal deposits are known as Lewy bodies and interfere with the chemicals in the brain, which, in turn, cause difficulties in movement, thinking, cognition, mood, and behavior.
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LBD is a progressive disease that can be quite challenging to diagnose as its early symptoms greatly resemble those in other psychiatric disorders or brain diseases. Lewy body dementia can also occur along with other brain disorders in a patient. Since it is a progressive disease, the symptoms start slowly and gradually worsen over time.
It is not a completely treatable disorder and lasts an average of five to eight years from the point of diagnosis to the time of death. However, it can range between two to twenty years for some people, depending upon how quickly the symptoms intensify, the patient’s age, and overall health.
Is Lewy body dementia the same as other kinds of dementia?
Lewy body dementia is regarded as one of the most common causes of dementia. Dementia is usually considered as one large umbrella term that covers several disorders that rob people of their ability to remember, act, understand, talk, and use their bodies. Some diseases that come under this umbrella term include:
- Lewy body dementia (also called dementia with Lewy bodies)
- Frontotemporal dementia (FTD)
- Alzheimer’s disease
- Huntington’s disease
- Parkinson’s disease dementia
- Mixed dementia
- Vascular dementia
The most common of these disorders is Alzheimer’s, which is also frequently the cause of confusion in diagnosis because it shares many symptoms with the others.
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However, there are specific differences between Alzheimer’s and LBD that can help in developing a clear diagnosis. People with Alzheimer’s typically suffer a more significant memory loss than LBD patients, but patients with LBD are more likely to exhibit the following symptoms:
- REM sleep disorder
- Struggles with incontinence
- Erratic body movements
- Hallucinations, delusions, or paranoia
- Frequent falls
- Persistent dizziness
What causes Lewy Body Dementia?
The definitive causes of LBD are unknown despite several attempts to learn more about its genetics and biology. However, scientists have several speculations about its causes, the most significant of which is the accumulation of Lewy bodies which results in the death of certain neurons in the brain. These neurons are responsible for the production of two vital chemicals that act as neurotransmitters (messengers between the brain cells): acetylcholine and dopamine. Acetylcholine is significant for learning and memory, whereas dopamine plays a prime role in movement, cognition, behavior, motivation, mode, and sleep.
What are the risk factors for Lewy body dementia?
Extensive studies are now unveiling the risk factors for LBD as well. Risk factors are the conditions that may elevate an individual’s chance of developing a particular health disorder. Some risk factors can be controlled or mitigated, such as blood glucose and cholesterol levels, whereas others cannot, such as family history or age.
Scientists have concluded that no specific lifestyle factors seem to affect an individual’s risk of LBD. Some common risk factors for this disorder include the following:
- Having certain health conditions, particularly REM sleep behavior disorder and Parkinson’s disease, which have been generally associated with a higher risk of Lewy body dementia
- Having a family history of LBD. Although LBD is not considered a genetic disorder, variations in three genes – GBA, SNCA, and APOE – are associated with an elevated risk of LBD.
- Other causes are generally unknown or are variable for different individuals.
Stages of Lewy Body Dementia
Since LBD is a progressive disease, it takes a long time to develop clearly discernible changes in an individual. There are generally seven stages of LBD:
Stage One: The normal stage
Stage one is the regular stage of dementia, where patients are absolutely normal and exhibit no signs and symptoms. However, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans of the brain may show some incidental findings during routine examinations. Some patients may deal with mood fluctuations or daytime sleeping with hallucinations in this stage.
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Stage Two: The stage with very mild symptoms
Although individuals in stage two of Lewy body dementia show some very minor symptoms, they are hardly noticeable and even impossible to detect in some cases. These mild symptoms may include mild forgetfulness, like forgetting names or facing difficulty finding familiar objects. However, patients can continue their daily activities and work without significant challenges.
Stage Three: The stage with mild symptoms
Patients with third stage Lewy body dementia show mild symptoms, which may include:
- Increased risk of falls
- Difficulties dealing with their daily life activities
- Mild problems with concentration
- Slight forgetfulness
- Mild memory loss
Stage Four: The stage of diagnosis
Patients with LBD generally have a confirmed diagnosis by this stage. However, the symptoms are still in the slight to the moderate stage and may include:
- Life disrupting forgetfulness
- Difficulty swallowing
- Excessive drooling
- Choking, aspiration
- Difficulties in performing daily life activities
- Increased daytime sleep but without much hallucinations
- High risk for potential health problems or opportunistic infections
- Difficulty in speaking properly
- Increased risk of falls
- Increased need for supervision or help
Stage Five: The stage with moderately severe symptoms
Symptoms in stage five range from moderate to severe and may include:
- Persistent confusion, disorientation, and inability to live alone
- Drastic memory loss
- Increased struggle with simple everyday activities
- Persistent fever
- High risk of skin diseases and opportunistic infections
- Higher need of almost constant supervision
- Retarded movement
- Constant delusions, fears, paranoia, anxiety, hallucinations
- Increased need for assistance while eating
Stage Six: The stage with severe symptoms
Stage six of LBD typically lasts for about 2.5 years, and an increase in the severity of symptoms is observed. Symptoms may include:
- Difficulty in recognizing family members
- Severe memory loss
- Severely diminished ability to speak
- Drastic personality changes
- High level of support is required for daily life activities
- Urine and bowel incontinence
Stage Seven: The stage with very severe symptoms
Stage seven lasts about 1.5 to 2.5 years. Patients in late-stage Lewy body dementia exhibit very severe symptoms, which may include:
- Minimal communication
- A severe decline in physical systems
- Inability to walk
- Severe cognitive impairment
- Severe and life-disrupting memory loss
- Requirement of extensive assistance with life activities in the late dementia stage
- Need of round the clock support
Treatment for Lewy Body Dementia
Like its causes, Lewy body dementia does not have specific treatments or medications that may stop the symptoms from worsening or reverse them. However, certain medications can relieve the symptoms temporarily, and include the following:
- Acetylcholinesterase inhibitors
Acetylcholinesterase inhibitors work by elevating the levels of acetylcholine in the brain, thereby improving the ability of neurons to send and receive signals from each other. Some common drugs include Aricept (donepezil), Reminyl (galantamine), and Exelon (rivastigmine).
They may also help improve confusion, sleepiness, and hallucinations in early-stage patients. However, these drugs are not without their side effects, which commonly include muscle cramps, feeling sick, diarrhea, tiredness, headaches, and fatigue.
Memantine functions by blocking the effects of glutamate, which is a chemical produced in large amounts in the brain. It is used for moderate to severe dementia caused by Lewy bodies.
Memantine is a suitable alternative for patients who cannot take acetylcholinesterase inhibitors. Memantine usually has temporary side effects, including dizziness, constipation, headaches, etc.
- Other medications
Some other drugs include:
- Laradopa (levodopa) and Dopar – which may improve rigid limbs or mitigate movement problems
- Klonopin (clonazepam) or Melatonin – which may help with sleep disturbances
- Haloperidol and certain other antipsychotics – which may improve behavior and deal with emotional changes. These drugs can cause serious side effects and thus should be avoided whenever possible and monitored at all costs.
- Antidepressants – which help with mood fluctuations
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