Lewy Body Dementia
Overview
According to the Alzheimer’s Association, Lewy body dementia (LBD) is the third most common cause of dementia behind Alzheimer’s and vascular dementia. Lewy bodies accumulate in the brain, disrupting nerve signals and causing various symptoms including impaired cognition (thinking and memory), behavioral changes, movement issues or sleep issues.
Types
There are two diagnoses associated with LBD, producing similar symptoms.
- Dementia with Lewy bodies. Cognitive symptoms occur before or within a year of movement symptom onset
- Parkinson’s disease dementia. Typically, cognitive symptoms will develop one or more years following Parkinson’s disease onset.
Symptoms
Behavior and mood:
- Anxiety
- Delusions (false beliefs)
- Depression
- Hallucinations
- Loss of interest or motivation
Cognitive:
- Difficulty interpreting visual and spatial information
- Difficulty multi-tasking
- Fluctuating between confusion and alertness
- Impaired thinking, reasoning or judgment
Movement:
- Imbalance
- Slowness
- Stiffness
- Walking difficulties
Other parkinsonian features:
- Decline in voice quality
- Drooling
- Incontinence
- REM sleep behavior disorder (acting out dreams while sleeping)
- Small handwriting
- Stooped posture
Prevention
There are currently no known preventive measures known to reduce the risk of developing LBD. Incorporating healthy lifestyle changes such as a healthy diet, physical exercise, mental activities (e.g., hobbies or games) and social interaction may help some patients maintain function.
Risk Factors
- Being male; men have slightly greater risk than women
- Being over age 50 Medical conditions:
- Family history of LBD, although it is not considered genetic
Diagnosis
- Medical history and symptom review. The provider will review your symptoms and inquire about your ability to perform daily tasks.
- Physical examination. The doctor will perform a neurologic exam and may perform cognitive assessment testing or refer for neuropsychiatric evaluation.
- Diagnostic tests. Definitive diagnosis is currently made after death if Lewy bodies are seen on brain autopsy. MRI or CT scans of the brain may help rule out other causes of symptoms, such as stroke or tumor. EEG may show slowing of certain areas of the brain and can help rule out seizure.
Treatment
There is no known treatment to stop the progression of LBD, but symptoms may be treated with cautious use of medications and other therapies to help maintain function.
- Dementia medications may be prescribed for cognitive complaints.
- Parkinson’s disease medications (such as levodopa) are recommended for movement symptoms.
- Physical or occupational therapy is recommended for mobility and routine activities.
- Speech therapy may help improve speech or swallowing.
Follow-up Care
- Periodic office visits with your healthcare provider can help him or her assess your need for medication adjustments or provide referrals to specialty care.
- Follow-up visits with the healthcare provider should be scheduled for new or abruptly worsening symptoms to rule out infection, stroke or adverse effect of medication.