• Lewy Body Disease

    (Lewy Body Dementia; Dementia with Lewy Bodies)

    Definition

    Dementia is the progressive loss of memory and various other mental functions, including the ability to learn, reason, and judge. Lewy body disease is associated with the build up of Lewy bodies in regions of the brain. These are abnormal protein deposits inside cells that control certain aspects of memory and motor control.
    Brain Cells
    Neurons
    Copyright © Nucleus Medical Media, Inc.

    Causes

    It is not clear exactly what causes the build up of Lewy bodies in the brain. But the disease is linked to:

    Risk Factors

    Factors that can increase your chance of developing Lewy body disease include:
    • Gender: male
    • Age: 53-83 years
    • Family history of Lewy body disease, Parkinson's disease, or other dementias

    Symptoms

    Lewy body disease is characterized by:
    • Fluctuations in alertness and attention—frequent drowsiness, lethargy, staring into space, disorganized speech, and insomnia
    • Recurrent visual hallucinations
    • Poor regulation of body temperature and blood pressure
    • Obsessive compulsive behaviors
    • Forgetfulness
    • Parkinsonian motor symptoms—rigidity, loss of spontaneous movement
    • REM behavior disorder

    Diagnosis

    The only way to diagnose Lewy body disease is through an autopsy . A doctor can do tests to narrow the cause of dementia. You will be asked about your symptoms and medical history. A physical exam will be done. Other tests may include:
    • Memory, language, and other tests
    • Neuropsychological tests
    • Patient and family interviews
    • You may need to have pictures taken of your bodily structures. This can be done with:
    • You may need to have your bodily fluid tested. This can be done with blood tests.

    Treatment

    While there is no cure for Lewy body disease, there are treatments that can control the symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include:

    Medications

    These medicines may be used to help with the symptoms:
    • Donepezil and rivastigmine—to help with cognition; may worsen motor symptoms
    • Memantine—to improve behavioral symptoms
    • Levodopa—to help control rigidity and loss of spontaneous movement
    • Antidepressants
    • Anticonvulsants
    If you have Lewy body disease, you may be sensitive to medicines called neuroleptics. You may have adverse events with these medicines.

    Other Treatments

    You may benefit from:

    Prevention

    There is no known way to prevent this condition.

    RESOURCES

    Lewy Body Dementia Association http://www.lewybodydementia.org

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    Alzheimer Society http://www.alzheimer.ca

    Canadian Stroke Network http://www.canadianstrokenetwork.ca

    References

    Ballard CG, Chalmers KA, Todd C, et al. Cholinesterase inhibitors reduce cortical Abeta in dementia with Lewy bodies. Neurology . 2007;68:1726-1729.

    Bouchard RW. Diagnostic criteria of dementia [review]. Can J Neurol Sci . 2007;34:(Suppl 1)S11-18.

    Camicioli R, Gauthier S. Clinical trials in Parkinson's disease dementia and dementia with Lewy bodies [review]. Can J Neurol Sci . 2007;34:(Suppl 1)S109-117.

    Chou KL, Borek LL, Friedman JH. The management of psychosis in movement disorder patients [review]. Expert Opin Pharmacother . 2007;8:935-943.

    Dementia with Lewy bodies. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated September 11, 2012. Accessed February 21, 2013.

    Dementia with Lewy bodies information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/dementiawithlewybodies/dementiawithlewybodies.htm . Updated May 16, 2012. Accessed February 21, 2013.

    Emre M, Tsolaki M, Bonnucelli U, et al. Memantine for patients with Parkinson’s disease dementia or dementia with Lewey bodies: a randomised, double-blind, placebo controlled trial. Lancet Neurol . 2010;9(10):969-77.

    Goldmann Gross R, Siderowf A, Hurtig HI. Cognitive impairment in Parkinson’s disease and dementia with Lewy bodies: a spectrum of disease. Neurosignals . 2008;16:24-34.

    Jellinger KA. Formation and development of Lewy pathology: a critical update. J Neurol . 2009;256(Suppl 3):270-279.

    Kemp PM, Hoffmann SA, Tossici-Bolt L, Fleming JS, Holmes C. Limitations of the HMPAO SPECT appearances of occipital lobe perfusion in the differential diagnosis of dementia with Lewy bodies. Nucl Med Commun . 2007;28:451-456.

    Lewy body disease: LBD. Lewy Body Disease Association website. Available at: http://lbda.org/sites/default/files/booklet-for-newly-diagnosed-patients2.pdf . Accessed February 21, 2013.

    Meeus B, et al. The genetics of dementia with Lewy bodies: what are we missing? Arch Neurol. 2012;69(9):1113-8.

    Tarawneh R, Galvin JE. Distinguishing Lewy body dementias from Alzheimer’s disease. Expert Review of Neurotherapeautics . 2007;7:1499-1516.

    Weintraub D, Hurtig HI. Presentation and management of psychosis in Parkinson’s disease and dementia with Lewy bodies. Am J. Psychiatry . 2007;164:1491-1498.

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