Understanding Dementia: Lewy Body and Parkinson Related Dementia

[dropcap]L[/dropcap]ewy body dementia (LBD) was discovered in the early 1900s by a neurologist, Frederich H. Lewy, MD in the same lab as Dr. Alois Alzheimer. It is the third largest type of dementia. It is also the most misdiagnosed because it is often thought to be Alzheimer’s or Parkinson’s disease. However, LBD accounts for 10-25% of dementia cases. The abnormal cell (alpha-synuclein protein) is the main cause of the condition and it is not clear what the normal function is. This protein is also found in other conditions such as Alzheimer’s and Parkinson’s dementia and that is why it’s difficult to make the right diagnosis. There is no cure and no single test that can conclusively diagnose LBD except for a postmortem autopsy. However, there are some differences that can help a doctor diagnose, even with overlapping symptoms.

The symptoms of LBD are:

• Alternating levels of alertness that vary significantly in different times or on different days

• Visual hallucinations (people, children or animals)

• Delusions

• Trouble interpreting visual information

• Changes in thinking and reasoning

• Parkinson’s symptoms, such as hunched posture, balance problems and rigid muscles

• Acting out dreams that may be violent

• Malfunction of the “automatic” (autonomic) nervous system

• Memory loss that is significant but less noticed than in Alzheimer’s

Research has shown that LBD and Parkinson’s disease dementia are two different expressions of the same underlying problems with brain processing of the protein alpha-synuclein. In most cases doctors still diagnose both conditions separately. Diagnosis of LBD symptoms will include: dementia symptoms consistent with LBD which develop first; when both dementia symptoms and movement symptoms are present at the same time of diagnosis; when dementia symptoms appear within one year after movement symptoms. A person is diagnosed with Parkinson’s based on movement symptoms and then dementia symptoms appear a year or more later.

According to the US Alzheimer’s Association, “Key differences between Alzheimer’s and Lewy body dementia are:

• Memory loss tends to be a more prominent symptom in early Alzheimer’s than in early Lewy body dementia, although advanced Lewy body dementia may cause memory problems in addition to its more typical effects on judgment, planning and visual perception.

• Movement symptoms are more likely to be an important cause of disability early in Lewy body dementia than in Alzheimer’s, although Alzheimer’s can cause problems with walking, balance and getting around as it progresses to moderate and severe stages.

• Hallucinations, delusions and misidentification of familiar people are significantly more frequent in early-stage Lewy body dementia than in Alzheimer’s.

• REM sleep disorder is more common in early Lewy body dementia than in Alzheimer’s.

• Disruption of the autonomic nervous system, causing a blood pressure drop on standing, dizziness, falls and urinary incontinence, is much more common in early Lewy body dementia than in Alzheimer’s.”

Questions about dementia:

Q: My father has lived with Parkinson’s disease for many years. Does this mean he will develop dementia?

A: Not necessarily. About 75% of people living with Parkinson’s will develop dementia.

Q: My mom frequently tells us stories about children she sees in the house. Sometimes she gets very upset about them and it is difficult to calm her down. Is there medication that can help the hallucinations?

A: Most behavioural medication was designed for people between the ages of 18 to about 40 with schizophrenia and other psychosis disorders. They were not designed for older people with dementia. However, they have used them for people living with dementia for symptoms of hallucinations and delusions as well as agitation. Research has shown that these medications have proven to be more harmful in our elderly population and especially if they have dementia. Medication for the treatment of behaviour is recommended only as a last resort and should be closely monitored by a medical professional. Tip: If your mom is worried about the children, validate her fear and worry before trying to distract her.

–By Regina Posvar

Regina Posvar is the current president of the Saint Lucia Alzheimer’s and Dementia Association and has been a licensed nurse for 25 years. SLADA is supported by volunteers and donations and aims to bring awareness and support by providing awareness public workshops, family support, memory screenings, the Memory Café, counselling and family training for coping skills and communication with persons living with dementia.