This common dementia is caused by a buildup of proteins in the brain. It affects thinking, memory and movement.
Lewy body dementia is the second most common type of dementia after Alzheimer's disease. Protein deposits called Lewy bodies develop in nerve cells in the brain. The protein deposits affect brain regions involved in thinking, memory and movement. This condition is also known as dementia with Lewy bodies.
Lewy body dementia causes a decline in mental abilities that gradually gets worse over time. People with Lewy body dementia might see things that aren't there. This is known as visual hallucinations. They also may have changes in alertness and attention.
People with Lewy body dementia might experience Parkinson's disease symptoms. These symptoms may include rigid muscles, slow movement, trouble walking and tremors.
Lewy body dementia symptoms can include:
Lewy body dementia is characterized by the buildup of proteins into masses known as Lewy bodies. This protein also is associated with Parkinson's disease. People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer's disease.
A few factors seem to increase the risk of developing Lewy body dementia, including:
Lewy body dementia is progressive. This means it gradually gets worse over time. As symptoms get worse, Lewy body dementia can lead to:
People who are diagnosed with Lewy body dementia have a gradual decline in the ability to think. They also have at least two of the following:
Other symptoms support a Lewy body dementia diagnosis. This includes problems with the autonomic nervous system. When this happens, the body isn't able to regulate blood pressure, heart rate, body temperature and sweating.
Sensitivity to medicines that treat psychosis also supports a diagnosis. This is particularly true for medicines such as haloperidol (Haldol). Antipsychotic medicines aren't used for people with Lewy body dementia because they can make symptoms worse.
No single test can diagnose Lewy body dementia. The diagnosis is based on your symptoms and by ruling out other conditions. Tests might include:
Your doctor may check for signs of Parkinson's disease, strokes, tumors or other medical conditions that can affect the brain and physical function. A neurological exam tests:
A short form of this test, which assesses memory and thinking skills, can be done in less than 10 minutes. The test doesn't usually distinguish between Lewy body dementia and Alzheimer's disease. But the test can determine whether you have cognitive impairment. Longer tests that take several hours help identify Lewy body dementia.
These can rule out physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.
Your doctor might order an MRI or CT scan to identify a stroke or bleeding and to rule out a tumor. Dementias are diagnosed based on the medical history and physical examination. But certain features on imaging studies can suggest different types of dementia, such as Alzheimer's or Lewy body dementia.
If the diagnosis is unclear or the symptoms aren't typical, you may need other imaging tests. These imaging tests may support a diagnosis of Lewy body dementia:
You may need a sleep evaluation called a polysomnogram to check for REM sleep behavior disorder. You also may need an autonomic function test to look for signs of heart rate and blood pressure instability.
In some countries, health care professionals also might order a heart test called myocardial scintigraphy. This checks the blood flow to your heart for indications of Lewy body dementia. However, the test isn't used in the United States.
Research is ongoing into other indicators of Lewy body dementia. These biomarkers might eventually enable early diagnosis of Lewy body dementia before the full disease develops.
There's no cure for Lewy body dementia, but many of the symptoms can improve with targeted treatments.
Cholinesterase inhibitors. These Alzheimer's disease medicines work by increasing the levels of chemical messengers in the brain, known as neurotransmitters. These chemical messengers are believed to be important for memory, thought and judgment. They include rivastigmine (Exelon), donepezil (Aricept, Adlarity) and galantamine (Razadyne ER). The medicines may help improve alertness and thinking. They also may reduce hallucinations and other behavioral symptoms.
Possible side effects include stomach upset, muscle cramps and urinating more often. It also can increase the risk of certain cardiac arrhythmias.
In some people with moderate or severe dementia, an N-methyl-d-aspartate (NMDA) receptor antagonist called memantine (Namenda) might be added to the cholinesterase inhibitor.
Certain medicines can worsen memory. Don't take sleep aids that contain diphenhydramine (Advil PM, Aleve PM). Also don't take medicines used to treat urinary urgency such as oxybutynin (Ditropan XL. Gelnique, Oxytrol).
Limit sedatives and sleeping medicines. Talk to a health care professional about whether any of the medicines you take might make your memory worse.
Antipsychotic medicines can cause severe confusion, severe parkinsonism, sedation and sometimes death. Very rarely, certain second-generation antipsychotics, such as quetiapine (Seroquel) or clozapine (Clozaril, Versacloz) might be prescribed for a short time at a low dose. But they're offered only if the benefits outweigh the risks.
Antipsychotic medicines can worsen Lewy body dementia symptoms. It might be helpful to first try other approaches, such as:
Symptoms and progression are different for everyone with Lewy body dementia. Caregivers and care partners may need to adapt the following tips to individual situations:
Limit caffeine during the day. Discourage daytime napping and offer activities for daytime exercise. This might help prevent nighttime restlessness.
Frustration and anxiety can worsen dementia symptoms. To promote relaxation, consider:
People with Lewy body dementia often have a mixture of emotions. The person may feel confused, frustrated, angry or afraid. They may not be certain about the future and may feel grief and depression. Offer support by listening. Provide assurance that the person can still enjoy life. Be positive and do your best to help the person retain dignity and self-respect.
If you're a caregiver or care partner for someone with Lewy body dementia, watch the person closely. Make sure the person doesn't fall, lose consciousness or have a bad reaction to medicines. Provide reassurance during times of confusion, delusions or hallucinations.
Caring for a person with Lewy body dementia can be exhausting physically and emotionally. You may have anger, guilt, frustration, discouragement, worry, grief or social isolation. Help prevent caregiver burnout by:
Many people with Lewy body dementia and their families can benefit from counseling or local support groups. Contact your local agencies on health or aging. Local agencies can help you connect with support groups, health care professionals, resources, referrals, home care agencies, supervised living facilities, a phone help line and educational seminars.
You might first discuss your symptoms with a health care professional. This person may refer you to a doctor trained in dementia. This is usually a doctor trained in brain and nervous system conditions, called a neurologist, or a doctor trained in mental health conditions, called a psychiatrist.
Ask a friend or family member to come to the appointment, if possible. This person can help you remember the information you're given and give your doctor information about you. Here's some information to help you get ready for your appointment.
Make a list of:
You, your spouse, partner or close friend are likely to be asked a number of questions about: