Understanding Lewy Body Dementia: Causes, Symptoms, and Treatment

Lewy body dementia is a very common form of dementia where the illness is caused by clumps of proteins known as Lewy bodies building up in the brain. They damage those regions of the brain that affect behavior, movement, and cognition. The condition gets more severe over time, leading to more intense episodes of symptoms. With time, Lewy bodies cause dementia. 

What is Lewy Body Dementia?

An abnormal deposit of alpha-synuclein, a type of protein in the brain, causes Lewy body dementia (LBD). These protein deposits, commonly called Lewy bodies, affect the brain and cause changes in cognition, creating problems with movement, thinking, behaviors, mood, and sleep. Lewy bodies are one of the most common causes of dementia in patients. It is a progressive disease with no known cure, but its symptoms can be managed in various ways. 

Types of Lewy Body Dementia?

Lewy body and Parkinson’s disease dementia are the two types of Lewy body dementia that are caused by the same underlying changes in the brain. These illnesses develop similar symptoms over time. Timing is the main difference between these two conditions, which means the thinking and movement symptoms occur at different times. 

Dementia with Lewy bodies creates problems in thinking first, then it starts affecting movement and hampering alertness. It moves towards muscle stiffness and difficulty moving. 

Parkinson’s disease Dementia starts showing symptoms of movement difficulties, and later, the problems start with thinking and behavior. Parkinson's disease doesn’t always lead to dementia

Lewy Body Dementia vs. Other Neurological Disorders

Lewy body dementia shares similar symptoms with other neurological disorders, but understanding its unique characteristics is important for an accurate diagnosis. 

Alzheimer’s disease: both forms of dementia cause cognitive impairment and behavioral changes. Alzheimer’s is caused by amyloid plaques and neurofibrillary tangles, while LBD has Lewy bodies. LBD causes hallucinations and progresses faster than Alzheimer’s.

Vascular dementia: memory loss, confusion, and thinking issues are common in both, but vascular dementia is a result of vascular damage in the brain and occurs suddenly. 

Frontotemporal dementia: it affects the frontal and temporal lobes, while LBD affects various regions of brain. FTD involves changes in languages, but there are no such symptoms in LBD

Symptoms of Lewy Body Dementia

The symptoms of Lewy body dementia are vast and caused by abnormal protein deposition in the brain. The symptoms vary significantly between individuals, making it difficult to diagnose. 

Cognitive Symptoms

• Visual hallucinations: this is one of the initial symptoms of Lewy body dementia. The occurrence of hallucinations, where the individual might see shapes, animals, objects, or people that aren’t there, is very frequent. It also involves hallucinations of sound, smell, and touch. 
• Movement and coordination issues: These symptoms include rigidity, slowed movement, tremors, and tripping while walking. These make it difficult for a person to move around, and loss of coordination makes it difficult for an individual to perform daily tasks. 
• Memory and Cognitive Functioning: Individuals with LBD have symptoms of confusion, poor attention, and memory loss. These symptoms are similar to those of Alzheimer's disease. 

Physical Symptoms

• Autonomic Nervous System Disruptions: Lewy bodies affect the autonomic nervous system, which controls automatic functions like blood pressure, heart rate, sweating, and digestion. This causes a drop in blood pressure, leading to dizziness and loss of bowel and bladder movement. 
• Motor skill complications: LBD causes slowed movements and rigidity or stiffness, which causes problems when performing everyday tasks such as eating, getting dressed, or bathing. Tremor is another symptom that occurs in LBD. Loss of balance is also common, which causes an individual to fall and can be very dangerous. 

Behavioral and Psychological Symptoms

• Attention Variations: This causes episodes of drowsiness. An individual can be seen standing for a long time, staring at the space. They take long naps during the day and have disorganized speech.
• Emotional Well-Being: Individuals with LBD may experience depression and anxiety, which can make them feel sad and hopeless. They constantly worry and are on edge. LBD makes them lose interest in their surroundings and get demotivated. Irritability can also be seen in them.
• Motivational Decline: The lewy body can disrupt the production of neurotransmitters like dopamine, which play a key role in motivation and movement. As a result, individuals become less enthusiastic and start withdrawing from social activities. 

Causes and Risk Factors

The given fact about what causes Lewy body dementia is the accumulation of Lewy body in the brain, but the cause of such an abnormality is unknown. Some say that genetics, environmental factors, and natural aging might lead to LBD in some individuals. 

Understanding Lewy Bodies

The abnormal accumulation of alpha-synuclein protein in the brain is known to cause Lewy bodies. The formation of Lewy bodies leads to Lewy body dementia and other neurodegenerative disorders like Parkinson’s disease. The communication pathways of brain cells get disrupted by these clusters of proteins, leading to the symptoms of Lewy body dementia. There are two types of Lewy bodies: diffused Lewy bodies, which are smaller and widespread, and filamentous Lewy bodies, which are larger and found in those brain regions associated with Parkinson’s disease. 

Genetic and Environmental Factors

Research is showing gene mutations as a cause of Lewy body dementia. APOE and GBA genes are the two genetic risk factors that have recently been identified as leading causes of LBD. As it is known that APOE increases the risk of developing Alzheimer's, emerging evidence shows that it also increases the risk of Lewy body dementia. The GBA genes are known to increase the onset of Parkinson’s disease and Lewy body dementia. These research findings have still not established that genetic changes cause the illness, as most cases aren’t inherited. 

Diagnosing Lewy Body Dementia

The diagnosis of Lewy body dementia can be difficult, as the symptoms may look like those of Alzheimer’s or other mental illnesses such as schizophrenia. Open conversations with the patient and the caregiver can help make a diagnosis and lead to proper treatment thereafter. 

Medical Tests and Procedures

As the diagnosis is difficult, only some tests can give accurate results. Symptoms are the basis of the diagnosis, which helps rule out other conditions. Medical tests include:

• Neurological and physical exam: the doctor might take a physical examination and movement of an individual to determine the cause of the symptoms and which brain region is affected. 
• Mental ability assessment: This test helps assess an individual's memory and thinking skills, which can help conclude any cognitive impairment. 
• Blood tests: any physical problems can be ruled out that might be affecting cognitive functions.
• Brain scans: an MRI or CT scan may be recommended to identify bleeding, a stroke, or a tumor. PET scans or SPECT scans can assess brain function and show reduced dopamine uptake in the brain
• Sleep test: A polysomnogram is done to check for any sleep disorders.

Importance of Early Diagnosis

• Early and accurate diagnosis can help an individual receive specific medications targeting LBD symptoms, which can potentially help manage the symptoms more effectively and slow the progression. 
• Prevent using harmful medications and treatments that can worsen the symptoms.
• Early detection can help in planning the future regarding legal and financial matters while they can. It also helps families and caregivers access support, gather information, and facilitate better care options.
• Knowing the diagnosis allows the individual to understand the illness and its progression. This will allow them to adjust to changes and manage expectations. 

Challenges in Diagnosis

1. Overlapping Symptoms: LBD symptoms are very similar to other neurodegenerative diseases. This can complicate the diagnosis process and may give inaccurate results. 
2. Lack of definitive tests: as discussed earlier, no single test can definitively diagnose LBD; it relies on combination of factors like family history, neurological examination, and brain imaging. 
3. Variability and fluctuations: different individuals have different symptoms of LBD even within the same subtype, which makes diagnosis challenging. The symptoms may fluctuate over time. 
4. Minimal access to specialists: healthcare professionals with no experience and training can find it difficult to provide an accurate diagnosis of LBD, particularly in the early stages. 

Treatment and Management

The damage caused by Lewy bodies to the brain cells cannot be stopped or slowed by any treatment, but current strategies focus on managing the symptoms of Lewy body dementia. The medication prescribed should be closely discussed with the medical professional. 

Medications

• Cholinesterase inhibitors: these medications increase the levels of neurotransmitters, which help with memory, thought, and judgment. They may also include rivastigmine (Exelon), galantamine (Razadyne ER), and donepezil (Aricept, Adlarity), which improve alertness and thinking and reduce behavioral symptoms. In some cases, a dose of NMDA is also used. 
• Carbidopa-levodopa- (Sinemet, Duopa, others) helps with rigidity and movement. It may also increase confusion and hallucinations. 
• Antipsychotics: these medications help treat hallucinations and delusions in LBD. 

Therapies and Lifestyle Changes

Apart from medications, therapies help greatly with LBD. Physical therapy helps improve balance, coordination, and strength to stay mobile and independent. Occupational therapy helps individuals learn ways to improve their everyday activities. Speech therapy can help improve an individual's communication skills and swallowing. 

Various lifestyle changes, like moving to a peaceful environment, can reduce clutter and allow individuals to manage various symptoms. Some symptoms don’t need medications, such as hallucinations, as the medication might make the hallucinations worse. Create a schedule for daily tasks and break them into smaller steps to achieve success; it can also be less confusing. 

Support for Caregivers

Caregivers face immense challenges in managing individuals with Lewy body dementia. Individual or group therapy can provide emotional support and a space to learn coping mechanisms. Support groups can offer interaction with caregivers facing similar challenges. Taking self-care will prevent burnout and allow them to take better care of their loved ones. Getting the required information and resources can empower them to make informed decisions. Participating in trainings and workshops can help caregivers learn new skills and techniques. 

Research and Future Directions

There are many questions related to Lewy body dementia that come up, like why certain proteins accumulate into Lewy bodies and how the symptoms occur due to Lewy bodies. The increasing number of questions gathers the attention of research communities. Research is going on to find the difference between LBD and Parkinson’s in regards to Lewy bodies and how genetic, underlying biology, and environmental risk factors contribute to the illness. Research about the biomarkers, screening tests, and new treatments is ongoing. There’s hope that one day there will be an effective treatment or cure to prevent and treat the disorder. 

Embracing Hope and Progress with Cadabams Hospitals

Lewy body dementia comes with its own set of challenges and problems that can be difficult to deal with. One needs a certain amount of knowledge and understanding of the disease to help the patient manage the symptoms of the illness. Cadabam has been helping people with mental illness for over 30 years. We have an experienced team of mental health professionals who leverage evidence-based and holistic treatment to help you manage the symptoms of Lewy body dementia.  Get in touch with us today. You can call us at +91 97414 76476. You can even email us at info@cadabamshospitals.com.

FAQ

What are the most common causes of dementia with Lewy bodies?

The definitive cause of dementia is unknown, but scientists have identified several factors that contribute to this condition. The accumulation of Lewy bodies, or proteins, in the brain leads to LBD. Lewy bodies interrupt the production of neurotransmitters, which results in movement and behavioral problems. Genetics and the environment can be other risk factors that lead to LBD. 

What are the first symptoms of Lewy body dementia?

The initial symptoms of LBD include hallucinations, confusion, difficulty focusing, and memory retention. Individuals also face mild tremors, muscle rigidity, imbalance, and reduced coordination. They become depressed, lack motivation, and lose interest in activities. Some individuals might also face sleep problems like insomnia and vivid dreams.  

What is the treatment for Lewy body dementia?

The treatment for LBD addresses various symptoms of the illness and eases the journey for an individual. There are medications, like cholinesterase inhibitors, that enhance memory and cognition. Carbidopa-levodopa helps with managing the symptoms of Parkinson’s disease, and antipsychotics help manage hallucinations and delusions. Therapies like physical, occupational, and speech therapy help with the condition. 

What are the behaviors of Lewy body patients?

Individuals with LBD have a wide range of behavioral changes. Abnormal protein deposits disrupt brain regions responsible for cognitive, emotional, and behavioral regulation. They experience visual hallucinations, delusions, disorientations, sleep issues, and face difficulty focusing. They also show signs of depression, anxiety, apathy, and irritability. 

Who is at high risk for Lewy body dementia?

Anyone can get affected by LBD, but there are some groups that are considered to be at higher risk. The age factor increases the chances, that people after 65 experience a decline in cognition. Some specific gene variants, like APOE and GBA, contribute to the disease. Dementia in families increases the risk, suggesting shared genetic and environmental factors.