what medications are used to treat lewy body dementia
Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, tin can lead to bug with thinking, movement, behavior, and mood. Lewy body dementia is one of the nigh common causes of dementia.
LBD affects more than 1 million individuals in the United States. People typically show symptoms at age l or older, although sometimes younger people have LBD. LBD appears to affect slightly more men than women.
Diagnosing LBD can be challenging. Early on LBD symptoms are oftentimes confused with similar symptoms establish in other brain diseases or in psychiatric disorders. Lewy body dementia can occur alone or forth with other brain disorders.
It is a progressive disease, significant symptoms start slowly and worsen over time. The affliction lasts an average of five to eight years from the time of diagnosis to decease, but tin range from ii to 20 years for some people. How quickly symptoms develop and change varies greatly from person to person, depending on overall health, age, and severity of symptoms.
In the early stages of LBD, symptoms can exist mild, and people can part fairly normally. As the illness advances, people with LBD require more help due to a decline in thinking and movement abilities. In the later on stages of the disease, they often depend entirely on others for assistance and care.
Some LBD symptoms may respond to treatment for a period of time. Currently, there is no cure for the disease. Research is improving our understanding of this challenging condition, and advances in science may 1 twenty-four hours atomic number 82 to meliorate diagnosis, improved care, and new treatments.
What are the causes of Lewy body dementia?
The precise cause of LBD is unknown, but scientists are learning more well-nigh its biology and genetics. For example, we know that an accumulation of Lewy bodies is associated with a loss of certain neurons in the brain that produce 2 important chemicals that act as messengers betwixt brain cells (called neurotransmitters). One of these messengers, acetylcholine, is important for retentivity and learning. The other, dopamine, plays an important role in behavior, cognition, movement, motivation, sleep, and mood.
Scientists are also learning about risk factors for LBD. A risk gene is something that may increase the chance of developing a disease. Some risk factors tin be controlled while others cannot. Age is considered the greatest risk factor. No specific lifestyle factor has been proven to increment one's hazard for LBD.
Other known chance factors for LBD include certain diseases and health conditions, especially Parkinson'due south affliction and REM sleep behavior disorder, which have been linked to a college hazard of LBD.
Having a family member with LBD also may increment a person'due south risk, though LBD is not considered a genetic illness. Variants in three genes — APOE, SNCA, and GBA — take been associated with an increased chance, just in most cases, the cause is unknown.
What are Lewy torso dementia signs and symptoms?
People with LBD may not have every symptom associated with the disease. Whatever sudden or major change in functional ability or behavior should be reported to a doctor.
The most common symptoms include changes in knowledge, move, slumber, and behavior.
Cognitive symptoms of Lewy body dementia
LBD causes changes in thinking abilities. These changes may include:
- Visual hallucinations, or seeing things that are not present. Visual hallucinations occur in upwardly to 80 pct of people with LBD, often early on. Nonvisual hallucinations, such equally hearing or smelling things that are non present, are less common than visual ones but may also occur.
- Unpredictable changes in concentration, attention, alacrity, and wakefulness from 24-hour interval to day and sometimes throughout the mean solar day. Ideas may be disorganized, unclear, or casuistic. These kinds of changes are common in LBD and may help distinguish information technology from Alzheimer's affliction.
- Astringent loss of thinking abilities that interfere with daily activities. Unlike in Alzheimer's dementia, memory issues may non be axiomatic at first but oft arise as LBD progresses. Other changes related to thinking may include poor judgment, confusion nigh fourth dimension and place, and difficulty with language and numbers.
Motility problems and Lewy body dementia
Some people with LBD may not feel pregnant motility problems for several years. Others may take them early on. At first, movement symptoms, such as a alter in handwriting, may be very mild and easily overlooked. Movement problems may include:
- Muscle rigidity or stiffness
- Shuffling walk, slow movement, or frozen stance
- Tremor or shaking, virtually ordinarily at balance
- Balance issues and repeated falls
- Stooped posture
- Loss of coordination
- Smaller handwriting than was usual for the person
- Reduced facial expression
- Difficulty swallowing
- A weak voice
Lewy body dementia and sleep
Sleep disorders are common in people with LBD, but are often undiagnosed. A sleep specialist can help diagnose and treat sleep disorders. Slumber-related disorders seen in people with LBD may include:
- REM slumber behavior disorder
- Excessive daytime sleepiness (sleeping two or more hours during the solar day)
- Insomnia
- Restless leg syndrome
Behavioral and mood symptoms of Lewy torso dementia
Changes in beliefs and mood are possible in LBD and may worsen equally the person'due south thinking abilities refuse. These changes may include:
- Depression
- Apathy, or a lack of interest in normal daily activities or events and less social interaction
- Feet and related behaviors, such as asking the same questions over and over or beingness aroused or fearful when a loved one is not nowadays
- Agitation, or restlessness, and related behaviors, such equally pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
- Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an matter or that relatives long dead are even so living.
- Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things
Other symptoms of Lewy body dementia
People with LBD can too feel significant changes in the part of the nervous system that regulates automatic functions such every bit those of the heart, glands, and muscles. The person may have:
- Changes in trunk temperature
- Bug with claret pressure level
- Dizziness
- Fainting
- Frequent falls
- Sensitivity to heat and cold
- Sexual dysfunction
- Urinary incontinence
- Constipation
- A poor sense of scent
Types of Lewy body dementia and diagnosis
LBD refers to either of 2 related diagnoses — dementia with Lewy bodies (DLB) and Parkinson's disease dementia. Both diagnoses take the same underlying changes in the brain and, over time, people with either diagnosis develop similar symptoms. The divergence lies largely in the timing of cognitive (thinking) and movement symptoms.
In DLB, cognitive symptoms develop within a year of motion symptoms. People with DLB have a refuse in thinking power that may await somewhat similar Alzheimer'due south illness. But over time, they also develop movement and other distinctive symptoms of LBD.
In Parkinson's disease dementia, cognitive symptoms develop more than a year afterward the onset of move symptoms (for example, tremor or musculus stiffness). Parkinson's affliction dementia starts as a motion disorder, with symptoms such as slowed motion, muscle stiffness, tremor, and a shuffling walk. These symptoms are consistent with a diagnosis of Parkinson'due south disease. Afterwards, cognitive symptoms of dementia and changes in mood and behavior may ascend.
Not all people with Parkinson's disease develop dementia, and information technology is difficult to predict who will. Many older people with Parkinson's develop some degree of dementia.
Talking to both patients and caregivers helps doctors make a diagnosis. It is important to tell the doctor about any symptoms involving thinking, move, sleep, behavior, or mood. As well, discuss other health problems and provide a list of all current medications, including prescriptions, over-the-counter drugs, vitamins, and supplements. Certain medications can worsen LBD symptoms.
Caregivers may be reluctant to talk virtually a person's symptoms when that person is nowadays. Enquire to speak with the dr. privately if necessary. The more data a doctor has, the more accurate a diagnosis can exist.
Treatment and treat Lewy body dementia
While LBD currently cannot exist prevented or cured, some symptoms may answer to treatment for a menstruation of time. An LBD treatment programme may involve medications, physical and other types of therapy, and counseling. A plan to make whatever home rubber updates and identify whatever equipment can brand everyday tasks easier.
A skilled intendance team often can suggest ways to improve quality of life for both people with LBD and their caregivers.
Building a Lewy body dementia care team
After receiving a diagnosis, a person with LBD may benefit from seeing a neurologist who specializes in dementia and/or movement disorders. Your master doctor tin can piece of work with other professionals to follow your handling program. Depending on an individual's detail symptoms, physical, oral communication, and occupational therapists, as well as mental health and palliative intendance specialists, tin be helpful.
Back up groups are some other valuable resources for people with LBD and their caregivers. Sharing experiences and tips with others in the same state of affairs can help people find applied solutions to day-to-day challenges and get emotional and social back up.
Lewy body dementia medications
Several drugs and other treatments are bachelor to care for LBD symptoms. It is important to work with a knowledgeable wellness professional because certain medications can make some symptoms worse.
Coping with cognitive changes
Some medications used to treat Alzheimer's illness too may be used to care for the cerebral symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemic in the encephalon that is of import for retention and thinking. They may also improve hallucinations, aloofness, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer's drug, rivastigmine, to care for cerebral symptoms in Parkinson's disease dementia. Several other drugs are being tested equally possible treatments for LBD symptoms or to disrupt the underlying disease process.
Treating move symptoms in Lewy body dementia
LBD-related motility symptoms may be treated with medications used for Parkinson's illness, called carbidopa-levodopa. These drugs can assist brand information technology easier to walk, exit of bed, and move around. However, they cannot stop or reverse the illness itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Considering of this hazard, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson'due south medications are less ordinarily used in people with LBD due to a college frequency of side furnishings.
People with LBD may benefit from concrete therapy and practise. Talk with your doctor about what physical activities are best.
Managing sleep disorders in Lewy body dementia
Sleep problems may increase defoliation and behavioral problems in people with LBD and add together to a caregiver'due south burden. A doc tin order a sleep written report to identify any underlying sleep disorders such as sleep apnea, restless leg syndrome, and REM slumber behavior disorder.
REM sleep beliefs disorder, a mutual LBD symptom, involves acting out one's dreams, leading to lost sleep and even injuries to individuals and their sleep partners. Clonazepam, a drug used to control seizures and relieve panic attacks, is often effective for the disorder at very low dosages. Nonetheless, information technology can have side effects such equally dizziness, unsteadiness, and problems with thinking. Melatonin, a naturally occurring hormone used to treat insomnia, may too offer some benefit when taken solitary or with clonazepam.
Excessive daytime sleepiness is as well common in LBD. If information technology is severe, a slumber specialist may prescribe a stimulant to help the person stay awake during the day.
Some people with LBD have difficulty falling asleep. If trouble sleeping at night persists, a physician may recommend a prescription medication. It is important to notation that treating indisposition and other sleep problems in people with LBD has non been extensively studied, and that treatments may worsen daytime sleepiness and should be used with caution. Sleep issues tin also be addressed by fugitive lengthy naps, increasing daytime practice, and avoiding caffeine, booze, and chocolate belatedly in the day.
Treatment of behavior and mood problems in Lewy body dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, hurting, affliction, stress, or anxiety. They may besides exist the result of frustration, fear, or feeling overwhelmed. The person may resist intendance or lash out verbally or physically.
Medications are advisable if the behavior interferes with the person's intendance or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of fourth dimension is recommended.
The commencement step is to visit a doctor to see if a medical status unrelated to LBD is causing the trouble. Injuries, fever, urinary tract or pulmonary infections, pressure level ulcers (bed sores), and constipation tin can worsen behavioral issues and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For instance, some medications for slumber problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-feet medicines tin can actually increase feet in people with LBD. Review your medications with your doctor to decide if any changes are needed.
Cholinesterase inhibitors may reduce hallucinations and other psychiatric symptoms of LBD, but they may have side effects, such as nausea, and are not ever effective. However, they tin can be a good first choice to treat behavioral symptoms. Cholinesterase inhibitors exercise not touch behavior immediately, so they should be considered equally part of a long-term strategy.
Antidepressants can be used to treat depression and feet, which are mutual in LBD. Many of them are often well tolerated past people with LBD.
In some cases, antipsychotic medications are necessary to treat LBD-related behavioral symptoms to improve the quality of life and safety of the person with LBD and his or her caregiver. These types of medications must be used with circumspection because they can worsen movement symptoms and cause severe side effects, such as defoliation, farthermost sleepiness, and low blood pressure level that can result in fainting. In rare cases, a potentially deadly condition called neuroleptic malignant syndrome can occur. Symptoms of this condition include high fever, muscle rigidity, and muscle tissue breakup that can pb to kidney failure. Report these symptoms to your doctor immediately.
Antipsychotic medications increase the hazard of death in all elderly people with dementia but tin can exist particularly unsafe in those with LBD. Doctors, patients, and family members must weigh the risks of antipsychotic utilise against the risks of physical harm and distress that may occur every bit a result of untreated behavioral symptoms.
Other treatment considerations
LBD affects the part of the nervous arrangement that regulates automatic actions similar blood pressure and digestion. One common symptom is orthostatic hypotension, a drop in blood pressure level when standing up that tin cause dizziness and fainting. Elementary measures such equally leg elevation, rubberband stockings, and, when recommended by a doctor, increasing table salt and fluid intake, can assistance. If these measures are not enough, a doctor may prescribe medication.
People with LBD are oft sensitive to prescription and over-the-counter medications for other medical conditions. People with LBD should tell their doctors about every medication they take, including prescription and over-the-counter medicines, vitamins, and supplements. If surgery is planned and the person with LBD is told to stop taking all medications beforehand, inquire the doctor to consult the person's neurologist to develop a plan for careful withdrawal. In addition, talk with the anesthesiologist in advance to hash out medication sensitivities and risks unique to LBD. People with LBD who receive sure anesthetics may become confused or delirious and have a sudden, significant decline in functional abilities, which may become permanent.
Depending on the procedure, possible alternatives to general anesthesia may include a spinal or regional block. These methods are less probable to issue in defoliation afterwards surgery. Caregivers should likewise discuss the use of strong pain relievers after surgery because people with LBD can go febrile if these drugs are used likewise freely.
Lewy body dementia research
Many avenues of research are being explored to amend our understanding of LBD. Some researchers are working to identify the specific differences in the encephalon between the ii types of LBD. Others are looking at the disease's underlying biology, genetics, and environmental risk factors. Notwithstanding other scientists are trying to identify biomarkers (biological indicators of disease), improve screening tests to assist diagnosis, and research new treatments.
Scientists hope that new cognition most LBD will 1 day lead to more effective treatments and even ways to cure and prevent the disorder. Until and then, researchers need volunteers with and without LBD for clinical studies.
NIH and other groups help people acquire most clinical trials and studies and find inquiry opportunities virtually them. Visit the post-obit websites for details:
- Alzheimers.gov (search using the category "Related Dementias")
- Lewy Body Dementia Association
- ClinicalTrials.gov
For more data about Lewy body dementia
NIA Alzheimer's and related Dementias Education and Referral (ADEAR) Center
800-438-4380
adear@nia.nih.gov
world wide web.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and free print publications near Alzheimer's and related dementias for families, caregivers, and wellness professionals. ADEAR Heart staff reply telephone, email, and written requests and make referrals to local and national resources.
Alzheimers.gov
world wide web.alzheimers.gov
Explore the Alzheimers.gov portal for data and resources on Alzheimer's and related dementias from beyond the federal regime.
Lewy Body Dementia Association
404-935-6444
800-539-9767 (LBD Caregiver Link)
world wide web.lbda.org
Michael J. Fob Foundation for Parkinson's Research
800-708-7644
www.michaeljfox.org
Parkinson's Foundation
800-473-4636
helpline@parkinson.org
www.parkinson.org
This content is provided past the NIH National Constitute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.
Content reviewed: July 29, 2021
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Source: https://www.nia.nih.gov/health/what-lewy-body-dementia-causes-symptoms-and-treatments
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