One-third of cases are caused by Lewy bodies
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When we think of dementia as a disease, the first thought is Alzheimer's, but there is another form of dementia that accounts for about a third of all cases diagnosed.
Dementia with Lewy bodies differs from Alzheimer's in that in addition to cognitive dysfunction, there is a motor skill component that also resembles some Parkinson's disease symptoms. The disease is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time.
Help is available
Lewy Body Dementia Association: a nonprofit organization providing information and assistance to individuals with the disease, caregivers and medical professionals. Call LBDA at (800) 539-9767 or visit www.lbda.org.
Alzheimer's Association: provides information on the disease and other dementias, and can assist in finding local support services. Call the 24/7 helpline at (800) 272-3900 or visit www.alz.org.
Social Security Administration: has a "compassionate allowance" program in which workers diagnosed with dementia with Lewy bodies can qualify for Social Security disability benefits. For more information, call (800) 722.1213 or visit www.ssa.gov.
The hallmark brain abnormalities linked to DLB are named after Dr. Frederick H. Lewy, the neurologist who discovered them while working in Dr. Alois Alzheimer's laboratory during the early 1900s. Alpha-synuclein protein, the chief component of Lewy bodies, is found widely in the brain, but its normal function isn't yet known.
Lewy bodies are also found in other brain disorders. Many people with Parkinson's eventually develop problems with thinking and reasoning, and many people with DLB experience movement symptoms, such as hunched posture, rigid muscles, a shuffling walk and trouble initiating movement.
Dr. Douglas Black, a neurologist at Portsmouth Regional Hospital, said DLB is distinguished by cytoplasmic inclusion of a particular protein in the brain. The cause is unknown and, like Alzheimer's disease, there is no known cure.
"The protein can be viewed on a pathologic slide of a brain biopsy, post mortem," Black said. "It may be hard to clinically differentiate from Alzheimer's at first, but what we look for is someone who seems to exhibit the cognitive signs of Alzheimer's, but also has some elements of Parkinson's disease. They usually present with bradykinesia, meaning slowness, stiffness, decreased muscle tone, but not with the tremors generally associated with Parkinson's."
Even the cognitive issues are not exactly the same as with Alzheimer's disease, which usually affects short-term memory.
"There can be some visual/spatial problems," Black said. "Patients are more prone to orthostatic blood pressure, meaning it changes from a prone to a sitting or standing position. There are more likely to be fluctuations in the level of attention spans. Their face may take on a masked appearance. Patients can have problems finding their way around or drawing something like a clock when asked to."
Dr. Karl Singer is board certified in internal medicine and geriatrics, and has a family practice at Exeter Hospital. He is also the medical director at the Rockingham County Nursing Home. He said he would suspect DLB in a patient who presents with Parkinson-type symptoms as well the attention and hallucinogenic effects of Alzheimer's disease.
"In this condition, there is often a rapid onset of symptoms, but the duration of the disease has about the same course as Alzheimer's — about eight years," Singer said. "Notable here is that dementia diseases are now at least as expensive in terms of care costs as is cancer. The long-term care aspects of dementia are very costly to families."
There is no known evidence of a genetic component to DLB, but Black said it can't be ruled out in some cases. Treatment for the condition is not curative, but is based on symptomatic treatments.
"Some drugs used to treat Parkinson's or Alzheimer's are used," Black said. "We must be very careful and sensitive with the use of any of the antipsychotic drugs. If there is a certain level of dysfunction of the neurotransmitters in their brain, we can actually make the condition worse."
Singer said it is important for medical professionals to recognize DLB by the difference in symptoms and because of what to avoid in terms of the treatment. He said treatment tends to be more palliative, to reduce suffering and to help the patient stay awake, as that can be a problem for many DLB patients.
"We don't want patients to wander and get lost," Singer said. "We want to avoid falls. Often when the patient becomes a wanderer, or has a high level of incontinence, it becomes too difficult for the family and long-term care is needed."
Help is available
Lewy Body Dementia Association: a nonprofit organization providing information and assistance to individuals with the disease, caregivers and medical professionals. Call LBDA at (800) 539-9767 or visit www.lbda.org.
Alzheimer's Association: provides information on the disease and other dementias, and can assist in finding local support services. Call the 24/7 helpline at (800) 272-3900 or visit www.alz.org.
Social Security Administration: has a "compassionate allowance" program in which workers diagnosed with dementia with Lewy bodies can qualify for Social Security disability benefits. For more information, call (800) 722.1213 or visit www.ssa.gov.
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