Dementia with Lewy Bodies (DLB) is a condition characterized by severe mental disability caused by abnormal protein deposits called alpha-synuclein (or Lewy bodies) in the brain. These deposits affect the chemicals in the brain causing changes, which in turn, lead to thinking and movement disorders, as well as behavior and mood changes. It is a common cause of dementia, just like Alzheimer's disease and other vascular diseases.

Lewy body dementia involves changes that affect one's ability to perform normal activities such as personal care, household tasks, and other types of work. There are two types of the disease: one is dementia with Lewy bodies and the other is Parkinson's disease dementia. They have similar symptoms and may be difficult to distinguish from one another. These conditions are also similar to other disorders characterized by dementia such as Alzheimer's disease. Furthermore, they may also occur at the same time in an individual.

Lewy Body Dementia Stages and Symptoms

LBD is a condition that affects the elderly, with symptoms typically beginning at age 50 onwards. However, sometimes, younger individuals may be affected. It appears to be more common in men than women.

Symptoms appear progressively, and may start gradually, only to worsen over time. Lewy body dementia lasts an average of 5-7 years from its diagnosis till death, although one's time span can range from 2-20 years, depending on the patient's age, overall health, and severity of the disease.

Early Stage Dementia with Lewy Bodies

In the early Lewy body dementia stages, usually before diagnosis, symptoms are mild, so patients can function normally. With advancement of the disease, mental and functional abilities decline, and patients require more help. In later stages, they become entirely dependent on others for support and care.

In early stage, symptoms may include visual hallucinations, decreased alertness and slowing of movements. In older people, these are sometimes mistaken as signs of physical illness such as an infection. However, symptoms persist long after the infection has resolved.

Late Stage Dementia with Lewy Bodies

As one gets to late Lewy body dementia stages, both mental and movement symptoms will be more serious and evident. For example, patients will have evident memory loss and delusions. They may become restless at night, and they may thrash and throw off bed sheets while asleep. And in worst condition, life-threatening infections would also occur.

Other symptoms may also become more frequent, including:

• Mental problems: forgetfulness, loss of interest, difficulty concentrating, visual problems, difficulties with spatial awareness, slower thinking and mental confusion.
• Motor problems: Parkinsonism (slow, small movements), shuffling walk, stiff limbs, and tremor.
• Psychiatric problems: agitation, hallucinations, delusions, sleepwalking, mood swings, aggression, anxiety, obsessive/compulsive symptoms and depression.
• Sleep disorders: daytime sleepiness, trouble sleeping at night, difficulty staying asleep, restless legs syndrome, scary dreams, or acting out dreams.
• Autonomic dysfunction: dry skin, irregular heartbeat, decreased blood pressure, dizzy spells, poor regulation of body temperature, and bladder/bowel problems.

Diagnosing Lewy Body Dementia

It may be difficult to differentiate Lewy body dementia stages from other disorders characterized by loss of mental ability, especially in the elderly. There are many different causes of dementia symptoms and it is important to determine if the underlying cause is reversible with treatment.

Currently, there is no sure way to confirm LBD in a living patient. The definitive diagnosis is possible only at autopsy during the microscopic examination of the brain showing the presence of Lewy bodies. This means that a clinical diagnosis is usually made only on the basis of symptoms, medical history, some test results, and response to treatment.

Differences Between Alzheimer's and DLB

The differences are closed related to symptoms in different Lewy body dementia stages and that of Alzheimer's.

• Memory loss is more obvious with early Alzheimer's; with DLB, memory issues and problems with planning, judgment and visual perception are more likely to occur in an advanced stage.
• Movement problems and disability are more common in early DLB; with Alzheimer's, similar problems such as difficulty walking or balancing happen in moderate and severe stages.
• Compared to Alzheimer's, delusions, hallucinations, REM sleep disorder, and failure to identify familiar people are more common in the early stages of DLB.
• Furthermore, people who have DLB are more likely to experience autonomic nervous system dysfunction, causing them to feel dizzy on standing because of a drop in blood pressure, to sustain more falls, and to suffer from urinary incontinence, than those with Alzheimer's.

Managing/Living with Lewy Body Dementia

A person who is diagnosed with LBD must consult a neurologist who specializes in the treatment of dementia and other movement disorders. These doctors are often found in academic medical centers in large communities. However, a general neurologist can also be part of a medical team, which could be referred by your primary care physician.

There is no cure for LBD, but some symptoms temporarily respond to treatment.

1. Drug Therapy

Drug therapy is the mainstay of treatment for dementia with Lewy bodies and is much like that of Parkinson's disease or Alzheimer's disease.

• These include acetylcholinesterase inhibitors, which help decrease confusion and mental instability, agitation and hallucinations. Atypical neuroleptic or antipsychotic drug is typically the first choice for agitation and hallucinations. It is important to treat these symptoms because they can result in accidents, injuriesor unsafe behavior. However, standard antipsychotic drugs (haloperidol) are not recommended because many people with LBD may be extremely sensitive to them.
• Other drugs that are widely used to relieve symptoms include antidepressants like selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase-B inhibitor (MAOI), and tricyclic antidepressants. In older people, combining these drugs is not usually recommended to avoid severe side effects.
• Some research suggests the use of vitamin E to slow the progression of dementia in Alzheimer's disease, but there is still no proof that this antioxidant works in LBD.

2. Non Non-Medical Therapies

Other non-medical therapies include diet, physiotherapy, occupational therapy, and speech therapy to help manage symptoms. Neurologists can work with healthcare providers to manage particular symptoms through various Lewy body dementia stages such as:

• Physical therapists, to help manage movement problems using general physical fitness programs, strengthening, cardiovascular, and flexibility exercises, and gait training.
• Speech therapists, to help improve voice volume, projection, and difficulties with swallowing.
• Occupational therapists, to help the patient carry out daily activities independently, such as bathing and eating.
• Music or art therapists, to provide meaningful activities to help improve well-being and reduce anxiety.
• Mental health counselors, to help patients and their families learn how to cope with behaviorsand emotions and to help plan for their future.

3. Support

Another valuable resource is support groups for people with LBD as well as their caregivers. These groups encourage sharing of experiences and tips with people in the same situation to identify practical solutions for daily challenges and to get social and emotional support.