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Hallucinations, brief periods of confusion, falling down - these signs could be from Dementia with Lewy Bodies (DLB), an often misunderstood diagnosis.
She saw children in the living room, but no one else did. Never did she say she had hallucinations, but her family finally assumed that was what was happening. Sometimes she fell for no clear reason, once just when she turned around to walk away. Then, when she had periods of “blanking out,” short periods of confusion, they took her to be examined. Specialists experienced in diagnosing and treating dementia decided the best diagnosis for her was Dementia with Lewy Bodies (DLB), sometimes called Lewy Body Dementia or Lewy Body Disease. What Is DLB?First, a quick grounding in terminology. “Dementia” is an umbrella word, covering all the diseases that produce progressive loss of brain function, and including especially memory loss. The most common cause of dementia in the US is Alzheimer's Disease. The second most common is Vascular Dementia. The third is Dementia with Lewy Bodies, accounting for up to 20% of dementia cases. DLB’s underlying cause—the brain pathology—is related to Lewy Bodies. These are microscopic particles that reflect dying or dead brain cells. Lewy Bodies were first described by Dr. Fredrich Lewy in his studies of Parkinson’s Disease. The difference between Parkinson’s Disease and DLB is that in DLB, the Lewy Bodies are in the cortex, the thinking part of the brain, not in the muscle control part of the brain. Lewy bodies are thought to be misfolded alpha-synuclein (a protein), and DLB is within the spectrum of alpha-synuclein pathologies. The disease process that causes Lewy Bodies is not well understood. Genetics (family history) may play a big part. The Lewy Bodies are often accompanied by amyloid plaques, which seem the same as in Alzheimer's. In addition, classic Alzheimer's may co-occur in DLB. DLB causes brain nerve cell death especially in the frontal brain sections. It affects several neurochemical systems: dopamine, acetylcholine, serotonin, and norepinephrine. How is ‘Lewy’ Pronounced?In America, it is usually pronounced “loo’-ee.” Dr. Lewy was born in Germany, and the name may be pronounced “lay’-vee.” Interestingly, Dr. Lewy emigrated to the US, changed his name to Lewey, and, as a member of the US Army, fought against Germany in World War II. Signs Of DLBBesides hallucinations, brief periods of confusion, and falling due to stiffness, other signs include:
How DLB and Alzheimer's Are RelatedIn Alzheimer's, memory loss is the first sign. Hallucinations, physical signs such as falling, and periods of pronounced confusion occur later in the disease. It may be just the opposite in DLB: memory loss occurs after the physical signs and hallucinations. That’s why DLB can be thought of as Alzheimer's upside down. DLB Diagnosis Often MissedDLB is often missed as a diagnosis, the symptoms being attributed to Alzheimer's. Patients do not often admit having hallucinations, for fear of being thought “crazy.” Since hallucinations often occur when the person is not completely alert, which occurs around sleep, hallucinations are often attributed to dreaming. Falling and stiffness are often attributed to simply aging. Families may not have the person examined medically until memory loss is present. Then, the attention is on the memory loss, and attributed to Alzheimer's. WarningPersons with DLB are very sensitive to neuroleptic drugs such as Haldol, Risperdal, Seroquel, Abilify, and others that are sometimes used for hallucinations. Many experts say that most hallucinations need not be treated, anyway.
The copyright of the article Dementia With Lewy Bodies--DLB in Alzheimer's Disease is owned by James Cooper. Permission to republish Dementia With Lewy Bodies--DLB in print or online must be granted by the author in writing.
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