Q: My husband was diagnosed with LBD in about 2005 but then he did not have the symptoms described and the only way they could tell for sure is to do an autopsy after death. Then another MD said he did not have LBD but I think that now there may we some more concrete ways of determining whether or not he really does have LBD or just a typical Parkinson’s.
The reason for digging deeper is his poor sleeping ability because of gruesome nightmares that I believe are caused by the carbo 10/levo 100 and perhaps we need to change his medications. I live in California and my husband is in a facility here so the name of a Parkinson physician would be very helpful. We have seen several doctors during these last years and are still hoping to find someone who is proactive and can help him with the symptoms.
Jim is in his 70s. When he starts to tremor, he can become confused, agitated, worried, anxious, have memory problems, and delusions and hallucinations he says are really scary. He shuffles with a rigid walk and has slow movement.
Thank you for your time.
A: It certainly appears you could have written the answer yourself because you are so well-informed of all the symptoms and feel the combination carbodopa/levodopa may be contributory. I take my hat off to you since an education into this and every disorder that affects your family is vital.
Lewy bodies are abnormal deposits in areas of the brain that control memory and body movement, with lewy body dementia (LBD) being the second most common type of progressive dementia behind Alzheimer’s disease. To complicate the issue, this buildup is also seen in Parkinson’s, Alzheimer’s and several other disorders, making it particularly difficult for a physician to differentiate just which neurological disorder an individual may suffer from. Symptoms include muscle rigidity, tremor, slowed movement, daytime drowsiness, and periods of very vacant, non-expressive periods of staring into space. Symptoms may differ from patient to patient, with some individuals experiencing Parkinson’s traits first, followed by confusion and memory loss. For others, that confusion and memory loss may present first, followed by rigidity, a vacant stare, tremors, and more. Other symptoms of LBD may include muscle rigidity, depression, a shuffling gait, lack of facial expression, recurrent visual hallucinations, loss of spontaneous movement, and pronounced gait abnormality. Sleep disorders are common (observed in 85% of those with the condition) during the rapid eye movement (REM) phase that can result in the patient physically acting out.
The diagnostic workup for LBD, Parkinson’s disease and Alzheimer’s may appear similar in nature, beginning with a medical history likely provided by family and/or caregivers, neurological examination, lab testing for such things as a thyroid abnormality, B12 deficiency and more, plus a possible PET scan, MRI, or CT.
At this stage there are no known therapies to slow or completely halt the progression of LBD, however treatment is available and is geared toward controlling the numerous symptoms of the disorder. For example, if a gait abnormality, shuffling, rigidity and other motor skills are affected, carbidopa/levodopa commonly prescribed for Parkinson’s may be attempted for control; however, the problem with dreams and hallucinations are generally primary to the disease, not necessarily a side effect of the medication. Keep in mind that hallucinations and delusions, frequent symptoms of LBD, may be present with or without the drug regimen, however you can certainly speak with your husband’s neurologist to determine if an alternative drug might work better. Treatment may include cholinesterase inhibitors commonly prescribed for Alzheimer’s, the carbidopa-levodopa your husband is on, which is commonly prescribed for Parkinson’s, anti-psychotic meds to help with the hallucinations, and still other drugs to control his myriad of other symptoms. Anti-psychotics have the capability of causing more permanent harm than good, so they may not be your best choice. In terms of a “concrete” means of identification, the neurologist must weigh all the facts in order to make an educated decision; however, before that, he or she should be confident your husband has symptoms of Parkinsonism, that he also has repeated visual hallucinations and varying fluctuations in cognitive function and alertness. Additional signs and symptoms include a REM sleep disorder or an unstable heart rate/blood pressure readings, and uncontrolled body temperature. The two most common drugs for a sleep disorder are clonazepam and melatonin, with the latter likely being a better choice in the setting of cognitive impairment. You and your husband might get some well-defined answers on his condition if he were to visit a tertiary care center.
Readers who would like related information can order Dr. Gott’s Health Report “Parkinson’s Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
