The second most common dementia is Lewy Body dementia (LBD.) This form of cognitive impairment has different pathology and symptoms from Alzheimer’s disease. Dementia specialists world-wide feel that 15 - 20% of all cases of dementia may be attributed to either pure Lewy Body dementia or Lewy Body dementia mixed with other brain disorders such as Alzheimer’s disease.
The early stage symptoms of Lewy Body dementia are quite different from Alzheimer’s disease. Lewy Body patients have waxing and waning cognition. Some days they are able to think clearly and go about their daily activities quite normally. Then, in a matter of minutes to hours, they can become acutely confused. Alzheimer patients have good days and bad days, but never have completely normal memory and cognition. When patients have what is sometimes called a “Lewy spell,” they may have a “brown-out,” where they will be talking and then “space out” and stare into space. One Lewy Body patient described these periods of confusion by saying, “It is like someone is blowing fog into my brain.”
Short-term memory in Lewy Body patients is usually quite good, unlike with those who are suffering from Alzheimer’s disease. Lewy Body patients often have severe visual-spatial difficulties. For example, a Lewy Body patient may go to the bathroom in a restaurant, get confused and not be able to find the way back to the table. During a Lewy spell, the patient may have difficulty concentrating and completing tasks.
Lewy Body patients share a similar brain pathology with people who have Parkinson’s disease. Patients with LBD often move very slowly, have a slight bent-forward posture, and tend to shuffle. They are at risk for falls because they do not have a good “righting reflex” if they trip on something or are jostled in a crowd. Many Lewy Body patients complain of having Restless Leg Syndrome, which can cause sleep disturbances. Unlike some Parkinson’s patients, people with LBD do not usually have a tremor.
Between 50 and 80 percent of all patients with Lewy Body dementia have visual or auditory hallucinations early in their disease. Lewy Body patients often report seeing little people or children sitting on their couch or small animals running around the home. Sometimes LBD patients will have phone conversations when there is no one on the line or will have conversations with photos of their loved ones. The Lewy Body patient may become very upset and agitated if family members argue with them about the reality of their visions. Caregivers often find it helpful to state, “I can’t see the children sitting on the couch, but I believe you do see them.”
If the physician tries to treat patients with Lewy Body dementia with anti-psychotic medications to get rid of the hallucinations, the Lewy Body patient often will have severe side effects from the medication, even on very low dosages. If Lewy Body patients are given anti-psychotic medication, they are at three to four times greater risk of severe side effects or even death than other patients. However, treatments for Alzheimer’s disease, such as Aricept, Exelon, and Reminyl, often times can improve Lewy Body dementia symptoms significantly. With treatment, many patients have a lessening of the frequency of Lewy spells, a greater ability to concentrate and a decrease in hallucinations.
It is very important for patients to receive the diagnosis of what type of dementia they are suffering from, so that they may be treated with the appropriate medication. In addition, caregivers can help their loved ones more effectively when they understand the diagnosis and cognitive impairments with which their loved one is grappling. Focusing on cognitive strengths and de-emphasizing deficits allows the Lewy Body patient to enjoy a better quality of life.
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