Lewy Bodies Dementia

Ashley M. Paille

Abstract.
There are hundreds of brain disorders that affect the human brain every year. The diseases range from minor to much more severe. This research paper focuses on a complex disease called Lewy Bodies Dementia. This disease is a primary cognitive brain disorder that mimics a previously discovered disease known as Alzheimer’s. Lewy Bodies Dementia was discovered about a decade after Alzheimer’s. The disease is classified as either a degenerative disease or a neurodegenerative disease. Various factors throughout a person’s lifetime will influence the nature and severity of the degeneration of the brain. Signs and symptoms of the disease are extremely vague and often have the presentation of other known cognitive brain disorders. This disease is incurable and is often treated on a case by case basis. It is also treated by trial and error due to the intense side effects of the medications such as drowsiness and confusion. Recent treatments such as the medication, Levodopa, have been made available although they do not cure the disease but rather slow down the progression of the disease.

Introduction.
Nearly 80% of individuals with Lewy Bodies Dementia will also have brain changes consistent with Alzheimer's disease. (Galvin, Duda, et al., 2010) Secondary to this high statistic, patients are often diagnosed with a non-specific initial diagnosis of Alzheimer's. This diagnostic experience can become extremely frustrating. (Galvin, Duda, et al., 2010) Lewy Bodies Dementia was not discovered until about ten years after the discovery of Alzheimer’s. As a result, to date, it is the most prevalent progressive dementia disease. Prior to the discovery of Lewy Bodies Dementia, the cognitive disease was classified as a whole under the term Alzheimer’s. Dementia is defined as a progressive decline in cognitive function. Lewy Bodies Dementia is caused by defects in the intraplasmic inclusion bodies that are found in the brain. These inclusions are located primarily in the intrafilament protein. (Spillantini, et al., 1997)
Radiography of a patient with a diagnosis of Lewy Bodies Dementia shows a significant increase of alpha-synuclein proteins. This particular protein is occurring in every human brain although in a patient with Lewy Bodies Dementia the presence of the protein is excessive. (Balasubramaniam and Galvin, October, 2013)

Lewy Bodies dementia encompasses two disorders. A primary indication of Lewy Bodies Dementia is found when there is a presence of the alpha-synuclein protein. A second key classification of the disorder is dementia with Parkinson’s. Both of these disorders include many of the same clinical features. The key difference in the initial diagnosis is if the disease initially started with movement disorders prior to the cognitive symptoms then they would classify it as dementia with Parkinson’s. (Ibid. et al., 2013) The diagnosis would also show the elevated levels of the protein. The protein in a normal functioning brain is a strand imitating the appearance of a spring coil. In a patient with Lewy Bodies Dementia the protein is in disarray and scattered throughout the brain matter. The goal of this paper is to inform you of Lewy Bodies Dementia, identify risk factors of the disease, educate you on signs and symptoms, and conclude with current management of the disease.

Neurodegenerative VS. Vascular

Distinguishing the differences between neurodegenerative and vascular dementia is pertinent to identify the causes and treatment options. Neurodegenerative disease or strokes appear to increase the pathological processes leading to dementia. (Kalaria., 1996) Patients with Alzheimer’s dementia almost always show lesions on radio graphical images. Neurodegenerative dementia primarily affects patients over the age of eighty-five. (Kalaria., 1996)

Vascular dementia is brought on primarily by lifestyle. Patients with vascular dementia often have a primary diagnosis such as obesity, hypertension, and/or diabetes. This would lead us to believe that more often than not vascular dementia is primarily brought on by an underlying medical condition. Patients with this disease often show infarcts and cerebral hemorrhages on brain images such as MRI’s, indicating that there has been a lack of oxygen to the brain at some time causing brain death.

Risk Factors.
The number one risk factor of Lewy Body dementia is increasing age. In the case of Parkinson’s dementia the primary symptom would be involuntary muscle movement followed by loss of cognitive function. Strokes, heart disease, dyslipidemia (abnormal amount of lipids in the blood), metabolic syndrome, and atherosclerosis are a few of the risk factors that increasing the odds of a patient developing Lewy Bodies Dementia.( Kalaria 1996) The number one risk factor of Lewy Body dementia is increasing age. Patients older than eighty-five are more at risk than a younger individual to develop Lewy Bodies Dementia strictly based on the gray matter that develops on the brain over time. (Nutrition Reviews, Vol. 68) Other common risk factors that correlate to Lewy Bodies Dementia are a family history of dementia, Down’s syndrome, and increase in the presence of the alpha-synuclein protein and illiteracy. It would be implicated that with an increase of the alpha protein, that is the only profound material that is located in mass amounts, the patient would be at a much higher risk of developing Lewy Bodies Dementia. An illiterate patient would unintentionally use far less brain activity therefore allowing areas of the brain to lay sedentary causing particular areas of the brain to die off. (Nils-Olof Hagnelius, 2009) The lowest risk factor that may play a part in the diagnosis of Lewy Bodies is being that of the female gender. It is unknown at this time as to why Lewy Bodies Dementia primarily affects females, although research shows that vascular dementia primarily affects men. (Nils-Olof Hagnelius, 2009)

Signs and Symptoms.
The primary symptom that presents in a person with Lewy Bodies Dementia is a change in the cognitive function. This includes a change from the person’s previous abilities, interference with daily functioning, and is a condition not caused by other illnesses. (Nils-Olof Hagnelius, 2009) The diagnosis of the disease is made by combining all of the symptoms and signs together. The four common symptoms of a patient with Lewy Bodies is a decrease in movement, visual hallucinations, spontaneous alterations in cognition, and sleep disorders causing people to act out their dreams. (McKeith, et al., 2005) The patient will start acting almost as if they have a mental disorder. The patients can see things that are not present and also will recall things or events that have not occurred. The most common presenting physical symptoms are memory impairment, depression, difficulties with problem solving, difficulty with gait, and tremors or stiffness. Depression often occurs because in the early stages of dementia the patient may be aware of their decreasing cognitive abilities. (Nils-Olof Hagnelius, 2009)

Management.
Lewy Bodies Dementia is not curable. The primary management approach in treating Lewy Bodies Dementia is to simply treat the symptoms. There are several medication that are used in managing the symptoms of the disease. If the patient is having involuntary muscle control, a medication such as Levodopa would be used. This is a dopamine inhibitor that would help in reducing the muscle tremors. The psychiatric symptoms are going to be the primary symptoms that are going to need to be treated. For psychiatric symptoms the medications include Chlormetiazole used as a sedative, Depakote which is used for mood disorders, and/or Risperdone which can also be used for mood disorders. (Lewy Body Dementia, Vol. 25) If the patient does not have anyone to take care of them it is inevitable that the patient would have to reside in a nursing home. The patient will eventually become completely incapable of caring for themselves and could also become a threat to themselves and others.

Conclusion.
In conclusion, Lewy Bodies Dementia is an extremely devastating disease brought onto the patient that also affects the family as well. The disease is progressive and incurable. There are several different risk factors that increase the odds of developing the disease. Once the patient is diagnosed with the disease the only way to treat the disease is to treat the symptoms. This is often a lengthy process and is done by trial and error. Often times the medications used in treating a patient with Lewy Bodies Dementia can cause extreme side effects including fatigue, drowsiness, and agitation. The disease is always being studied and researched and it is the scientist goals to one day find a cure or a preventable measure that can be taken to avoid the disease all together. Scientists are hopeful that in researching the alpha-synuclein protein, they will be able to find a link and this would lead to a cure. Until then living with Lewy Bodies Dementia is a sad and tragic illness for a family to deal with, the family member is physically there but as far as being there cognitively, they are not. It is a tragic illness for everyone involved.

References.

Byrne, J. (1997) Lewy Bodies Dementia. Journal of the Royal Society of Medicine Vol. 32, 14-15

Selkoe, J. (2002). Alzheimer's disease is a synaptic failure. Science 298, 189-791

Kalaria, (1996) R.N. Vascular basis for brain degeneration faltering controls and risk factors for dementia. Nutrition Reviews, Vol. 68, S74-S78,

Editorial Staff. ( March/April 2014) Lewy Body Dementia Canadian nursing home journal, Vol. 25, Number 1

Spillantini, M. ( 1997) &-Synuclein in Lewy Bodies. Nature Macmillan Publishers Ltd, Vol. 388, 839-840

Galvin. J.E., Pollack. J.C., Clinical Phenotype of Parkinson’s disease dementia, Neurology; 67; p. 1605-1611; 2006