LBD stands for Lewy body dementia. Lewy body dementia is a form of dementia that can occur as an independent or secondary disease. As part of this neurodegenerative disease, Lewy bodies appear in the brain, reducing the formation of dopamine.
What is Lewy body dementia?
Those affected suffer from progressive memory impairment. See AbbreviationFinder for abbreviations related to LBD.
Lewy body dementia is named after the neurologist Friedrich H. Lewy, who first described the disease in a chapter of his book. The so-called Lewy bodies were first discovered in connection with Parkinson’s disease. These are inclusions found in certain nerve cells other than the brainstem.
It has been known since 1989 that Lewy bodies can also occur in patients who do not show any symptoms of Parkinson’s disease. Lewy body dementia is the second most common form of dementia after Alzheimer’s and cannot be cured. The disease usually begins in old age, Lewy body dementia usually occurs between the ages of 50 and 83.
Causes
With advancing age, some people develop clumps of protein in the brain, which over time lead to failure symptoms. The Lewy bodies are made up of the protein alpha-synuclein, but it is not yet clear exactly what their role is in the human body. In the case of Lewy body dementia, clumps of this protein form in the brain cells, with inclusions mainly occurring at the nerve endings. Since the signal transmission takes place there, failure phenomena occur for this reason.
Symptoms, Ailments & Signs
Those affected suffer from progressive memory impairment, with alertness and mental ability subject to very rapid fluctuations over the course of a day. Furthermore, the patients suffer from optical hallucinations and see, for example, animals or people. Auditory hallucinations, such as hearing noises or voices, are less common.
These psychotic symptoms are very difficult to treat with antipsychotics, which are extremely poorly tolerated by many patients. The so-called Pisa syndrome or a very pronounced Parkinson’s syndrome then often occurs. However, some patients have symptoms of Parkinson’s disease even without antipsychotic treatment. These include hand tremors at rest, muscle stiffness, walking in small steps and hunched over, and a reduction in facial expression movements.
In addition, there are behavioral disorders in REM sleep (dream sleep). Those affected then live out their dreams very strongly because they lack motor inhibition. They scream and talk in their sleep, flail and may fall out of bed. Many patients also suffer from depression, hypotensive circulatory disorders and urinary incontinence. Most often they fall frequently, whereby those affected can also lose consciousness.
The ability to find one’s way around in everyday life is also being lost more and more. Patients have great difficulty planning or executing actions and making decisions. The pace of work slows down and there is a reduction in the ability to concentrate and control of attention.
In the later course, there are also impairments of speech, the patients become bedridden and in the final stage swallowing disorders also occur. In most cases, those affected then die of pneumonia. Mixed forms are also possible, i.e. symptoms of Alzheimer’s disease also occur. The symptoms that occur during the course of the disease process vary from person to person and depend on which areas of the brain are affected.
Diagnosis & course of disease
The doctor bases the diagnosis primarily on the typical symptoms that occur as part of this disease. It is important to think of this very special form of dementia, as many cases are often misdiagnosed as Alzheimer’s disease. Without the knowledge that psychotic symptoms have existed for a longer period of time, it can also be mistaken for delirium. Technical examination procedures are not particularly helpful in the diagnosis of Lewy body dementia.
The electroencephalogram shows only unspecific changes, and magnetic resonance imaging (MRI) or computed tomography (CT) does not show any characteristic findings either. With the help of a dopamine transporter examination, however, Lewy body dementia can be better differentiated from other forms. In the meantime, the focus is also being directed towards alternative therapies, such as cognitive or mental training.
If you strengthen your body and mind, you can significantly reduce the risk of developing dementia. After the diagnosis, the average duration of the disease is between six and eight years, but there are also very fast or very slow courses.
Complications
People with Lewy body dementia suffer from the usual symptoms of dementia. These can significantly restrict and reduce the quality of life of those affected. Not infrequently, the patients are then dependent on the help of other people in their everyday life and often pose a danger to themselves.
This mainly leads to disturbances in memory and hallucinations. Those affected cannot distinguish what is happening in reality. Likewise, patients may hear voices from other people who are not present. It is not uncommon for Lewy body dementia to lead to circulatory disorders and incontinence. Patients also suffer from depression and various behavioral disorders.
The sleep of those affected is often disturbed and there is a significant reduction in the patient’s ability to concentrate. Furthermore, Lewy body dementia can impair communication and also lead to pneumonia. Lewy body dementia can be treated with medication. However, not all symptoms can be limited, so that the course of the disease is not completely positive.
When should you go to the doctor?
Disturbances in memory performance should be examined more closely by a doctor even if there are minor abnormalities. Problems with memory retrieval, impaired memory, or memory lapses are a cause for concern. If no new knowledge can be acquired or if the person concerned objectively reproduces false memories, a doctor is needed. A loss of the usual level of performance and problems in coping with everyday obligations should be examined and treated. If you have trembling hands, inner restlessness or muscle problems, you should see a doctor.
Unsteady gait, dizziness or an increased risk of accidents should be discussed with a doctor. A stooping gait is a hallmark of Lewy body dementia. As soon as relatives notice this in the person concerned, they should work towards a doctor’s visit for the person concerned. Reduced exercise, restricted mobility or social withdrawal behavior are further warning signs that should be followed up. If incontinence, behavioral problems or circulatory problems occur, a doctor is needed.
If you experience depression, mood swings or personality changes, you should consult a doctor. If the abnormalities mentioned gradually increase over a period of several months, a doctor should be consulted immediately. Concentration disorders, a decrease in the usual work pace and problems in maintaining attention must also be examined by a doctor.
Treatment & Therapy
As with most forms of dementia, the loss of nerve cells cannot be stopped here either. However, since the psychotic symptoms that are particularly distressing for patients occur as a result of acetylcholine deficiency, they are given cholinesterase inhibitors. These include, for example, Rivastigmine or Donepezil Aricept. If the symptoms do not improve as a result, the antipsychotics clozapine or quetiapine are also used.
Clozapine requires special precautionary measures such as constant blood count checks. The motor symptoms of Parkinson’s are very difficult to treat because patients suffering from Lewy body dementia respond extremely poorly to anti-Parkinson’s drugs and the psychotic symptoms are exacerbated as a result. Small doses of L-Dopa are relatively well tolerated. Depression is treated with so-called selective serotonin reuptake inhibitors (SSRI).
Outlook & Forecast
However, not all symptoms become apparent as the disease progresses. As Lewy body dementia progresses, it is primarily characterized by enormous fluctuations in the patient’s mental capacity and alertness. Optical hallucinations, which become more and more detailed, occur more frequently. At the beginning of Lewy body dementia, patients can still distinguish between reality and hallucinations. However, they are no longer able to do this in the advanced stage.
In addition, slight symptoms of Parkinson’s disease later become visible, which are reflected above all in the trembling of the hands, in the stiffened movement sequences and in the unsteady gait. Lewy body dementia often results in marked insomnia and hyposomnia. This significantly disrupts the sleep-wake cycle. In the further course of the patient’s illness, urinary and fecal incontinence usually occur.
The patient’s risk of falling increases significantly due to the increasing restriction of movements. Falls often lead to disturbances of consciousness and loss of consciousness. Furthermore, frequent fractures and other serious injuries occur, which in turn lead to further limitations of the patient. In the later course, the patient’s weakness often increases due to such concomitant diseases. This leads to further deterioration of the immune system.
Prevention
So far it has not been possible to protect yourself against Lewy body dementia. However, there are some factors that reduce the risk of developing this form of dementia. This includes physical, mental and social activity as well as a balanced diet rich in vitamins E, C and beta-carotene. The focus is on low- cholesterol and low-fat food intake. The preventive measures also include the treatment of cardiac arrhythmias, high blood pressure and diabetes mellitus.
Aftercare
For those affected by dementia, aftercare consists of returning the patient to their home environment after an inpatient stay. The challenge is particularly evident in the dependency on caring relatives, who first have to adjust to their new role. The aftercare therefore not only affects the patient, but also their relatives, who must be informed and cared for in order to avoid being overwhelmed.
To make things easier, a semi-stationary stay in a clinic can make sense, because here the sick people are gradually released into everyday life. A certain degree of autonomy can be regained through therapeutic offers, depending on the stage of dementia. It is important that those affected are not overwhelmed by the therapists, as this can result in a renewed outbreak of the disease. The needs of each individual must be sensitively considered.
If the patient then moves completely into the home environment, it is also helpful here to receive regular visits to the doctor or to hire a professional nurse to provide support during the difficult initial period. Good everyday planning plays a major role so that the patient is challenged and there is no emptiness in which the disease can break out. Participation in social life, taking up old hobbies and regular training of body and mind are just a few recommendations.
You can do that yourself
The creation of a weekly plan provides structure and thus security. The work to be done and important dates can be entered here. Signs on cupboards that indicate the respective contents help with orientation in the apartment. Items like the key and purse are easier to find by assigning them fixed places. A piece of paper with important numbers right next to the phone ensures more security in emergencies. A home emergency call system can also help. Clearly structured shopping lists with the name and required quantity of the product are suitable for shopping. If cooking is made difficult by deficits in action planning, the use of recipes provides relief.
Since dementia affects, among other things, the ability to react, driving should be avoided. Instead, car pools can be formed, public transport can be used or relatives can be involved. If the person concerned was active in sports, it is advisable to obtain information about group offers.
Maintaining familiar interests and routines for as long as possible has a positive effect on body and mind alike. In advanced cases, it is advisable to draw up a power of attorney. In the event that the person concerned is no longer able to do so, a person of trust is authorized to make decisions on medical matters, regulate financial matters or sign contracts.
