Confusing the diagnosis

Written and Presented by Annie Brinson

Lewy Body Dementia was first discovered in the early 1900s when Friederich Lewy was studying Parkinson’s disease. He noted that the protein deposits in the brain affected the brain’s ability to function properly causing Parkinson’s like symptoms because of the depletion of the neurotransmitter, dopamine. (LBDA.org, 2011)

It is interesting to note that in Lewy Body Dementia (LBD) that the

proteins originate in the brainstem and work their way up into the brain and that in Parkinson’s

Disease the proteins originate in the brainstem and work their way

down. (Friedman, 2010, p.3)

1. Progressive cognitive decline that interferes with social or occupational function

2. Two or more of the following: a. fluctuating cognition with pronounced variations in attention and alertness, b. well-formed and detailed visual hallucinations, c. spontaneous motor features of Parkinson’s

3. Other criteria that are helpful, but not required are: frequent falls, syncope, medication sensitivity, and delusions (McKeith, 1996, p.3)

Another indicator for LBD is sleep disturbance. REM Sleep Behavior

Disorder (RBD) involves acting out dreams, sometimes violently.

Studies have shown that people who have RBD have a higher

frequency of developing LBD in the future. (Dementia, 2011)

Fluctuating memory loss Difficulty problem solving Inability to plan or to sequence Problems with concentration Dizziness and falls Changes in the autonomic system (e.g. blood pressure,

sexual dysfunction, sensitivity to temperature, and constipation)

Excessive sleepiness or sleep disturbance Psychiatric symptoms (depression, delusions, visual

hallucinations, and also smell and touch related hallucinations) (LBDA.org, 2011)

The most common treatment for LBD is with typical dementia

medications, like Aricept, Namenda, and Exelon, which are used to slow the progression of

the cognitive decline.

Treating Parkinsonism (movement disorders) typically involve using

the same medication used in Parkinson’s patients, Levodopa. However, it is best to use in low

doses because high doses can cause psychosis. If the Parkinsonism

features are not interfering significantly with the patient, then

the recommendation is to avoid using medication to treat.

It is common to treat psychosis and behaviors with antipsychotics; however,

a key component to LBD is the sensitivity to medication. When hallucinations, delusions, and

aggression do not respond to alternate treatment, it is best to treat with the

lowest dose possible of antipsychotics. The most commonly used antipsychotics

are Clozaril and Seroquel.

Physical therapy: Can improve gait, strength training, and flexibility

Occupational therapy: Works with fine motor skills and independence training (continence, hygiene, and transfers)

Speech therapy: Swallowing issues, voice volume, enunciation, and cognition

Individual and family counseling are strongly recommended to deal with depression, frustration, anxiety and loss of independence.

Support groups for both the individual and the family offer a forum to express concerns, frustrations, and support to others.

The diagnosis of LBD is not a death sentence. The key is to early

detection in order to symptom manage and to get an accurate

diagnosis. If this is done in a timely manner both quality and quantity of

life can be saved.

Dementia; findings in dementia reported from mayo clinic. (2011). Health & Medicine Week, (15316459), 731. Retrieved from http://search.proquest.com/docview/871789109?accountid=34899

Friedman, J. (2010). Recognizing dementia with lewy bodies in older people. Aging Health.

LBDA.org. (2011). Retrieved from http://lbda.org/McKeith, I. (1996). International consensus consortium criteria for

dementia with lewy bodies (Parkinsonian component). Alzheimer’s Drug Therapy Initiative. Retrieved from http://www.health.gov.bc.ca/pharmacare/adti/clinician/pdf/SECTION%205%20-%20Diagnostic%20Criteria%20for%20Dementias.pdf