Lewy Body Dementia
by Dr. Pat Borman
Director of Memory Disorders Center, Hawaii Pacific Neuroscience
Lewy Body Dementia (LBD) includes Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). These diseases are associated with Parkinson’s Disease (PD) and start with the abnormal accumulation of alpha synuclein in different parts of the brain. DLB precedes the diagnosis of PD, while PDD develops after the changes of PD have occurred. Currently 1.4 million people in the United States are coping with LBD. It is the third most common type of dementia after Alzheimer’s Disease and Vascular Dementia.
LBD has many unusual features such as variable levels of awareness and consciousness. They display rapid shifts between orientation and confusion, being alert or drowsy, and being at attention or unfocused. Changes in the processing of visual information are prominent with visuospatial changes such as struggling with depth perception, location, and the interrelationship of objects. There can be mistakes in decoding positional information such as above or below, going left or right, and inside or outside.
Compared to other types of dementia, LBD displays a range of psychiatric symptoms that include simple or complex visual hallucinations. A simple visual hallucination might be seeing a kitten in the room. A complex visual hallucination could involve people, actions, and purpose. Sometimes hallucinations are pleasant, warm, or reassuring while others are confusing, frightening, or even terrifying.
People with LBD can develop delusions (fixed beliefs that do not reflect reality) such as jealousy delusions that a spouse is unfaithful or persecutory delusions of being threatened or maltreated and are very real to the person with LBD. This can trigger a huge outpouring of emotions or misunderstandings. Agitation and anxiety can be triggered in people living with LBD, their families, and caregivers.
These changes can simultaneously occur with the motor symptoms of PD such as slowness, tremors, and difficulties with posture and balance. There are also many non-motor symptoms of PD such as dizziness, fainting, and falling due to uncontrolled changes in blood pressure. People with LBD can have severe difficulties with constipation, excessive drooling and abnormal temperature regulation.
Medications to treat the symptoms of LBD may be less effective than with other types of dementia. Sometimes the medications have a paradoxical effect. Instead of helping to reduce hallucinations the medications could make the hallucinations worse. It will be important to work closely with your medical team to find the best treatments for you. Your team could include neurologists, geriatrics specialists, psychiatrists and physical therapy experts with the goal to protect your comfort and safety. We diligently work to promote the highest quality of life possible for those living with LBD.
The Clinical Research Center at Hawaii Pacific Neuroscience is running new clinical trials in neurological conditions such as Dementia due to Alzheimer’s Disease, Parkinson’s Disease, and Traumatic Brain Injury. Our center runs Phase 1 to Phase 4 trials in global studies that are also running in top tier institutions such as Stanford, Mayo Clinic, and University of Amsterdam. Please email us at info@hawaiineuroscience.com or call our research hotline at (808) 564-6141 for more information.
