DEAR DR. GOTT: I have been waiting for a column about Alzheimer’s or a form of dementia like it. My brother has a dementia called Lewy body. I have never heard of this before and hope you can shed some light on this horrible disease. He was highly intelligent, and it always amazed me how much his brain stored because no matter how much I try to remember something, it just doesn’t stay.
It’s really hard to watch someone go from remembering everything to having to write it down so he doesn’t forget, doing unexplainable things and having mood swings. When you look at his face, you can see the blankness. When he tries to say something, he doesn’t know how to get it out. He forgets to swallow. Sometimes he knows me, and other times he forgets my name but remembers that we were connected. He now calls me by my first and middle name when he used to use my first name or call me “Sis.” Please help me to understand what is going on.
DEAR READER: Lewy body dementia is the second-most-common form of progressive dementia following Alzheimer’s disease. It is named because of the development of abnormal round structures (Lewy bodies) within the areas of the brain that control thinking and movement.
Symptoms can mimic those of Parkinson’s disease and Alzheimer’s. The first sign is often visual hallucinations, which can include seeing shapes, colors, animals and people that aren’t there. In some cases, sufferers may even carry on conversations with deceased friends and family. Other symptoms include delusions, having false ideas about a situation or person, sleep difficulties, fluctuating attention, including long periods of lethargy.
Still other symptoms include staring into space, disorganized speech and/or frequent episodes of drowsiness, cognitive problems such as a shortened attention span, memory loss and confusion, and movement disorders including a shuffling walk, rigid muscles, slowed movement or tremors.
Men over the age of 60 and those who have a family member with Lewy body dementia are at the highest risk of developing condition.
The cause isn’t known, but it may be related to Alzheimer’s or Parkinson’s. Lewy bodies are often found in the brains of those with Parkinson’s and other rare forms of dementia that contain a protein associated with Parkinson’s. Sufferers of Lewy body dementia also develop plaques and tangles within the brain that are associated with Alzheimer’s disease.
Treatment involves cholinesterase inhibitors typically prescribed for Alzheimer’s disease, Parkinson’s medications and antipsychotic drugs.
Cholinesterase inhibitors increase levels of neurotransmitters, which can help improve cognition and alertness and may reduce behavioral problems and hallucinations.
Parkinson’s medications reduce tremors, muscle rigidity and more, but may worsen confusion, delusions and hallucinations, making them inappropriate for some patients.
Antipsychotic drugs may diminish delusions and hallucinations; however, approximately one-third of Lewy body sufferers are dangerously sensitive to these drugs and may develop permanent damage such as worsening confusion or Parkinson’s symptoms.
When possible, it is beneficial to try non-medicinal therapies to help reduce symptoms, such as reducing clutter and distracting noises;, breaking tasks into smaller, easier steps; focusing on success, not failure; creating a structured routine; and having caretakers modify responses, such as not correcting and quizzing, but rather being reassuring and validating concerns. Encouraging exercise, making a nighttime ritual and improving communication are helpful when the patient is at home. Music, aroma and massage therapies can promote calmness and relaxation.
Finally, caregivers should provide the patient with a healthful diet and an exercise program, and attempt to keep stress levels down in order to provide the best possible help to the sufferer.
There will come a time when caring for the individual becomes too great. At this point, it is best to take a break, step back, and determine what the most appropriate plan of action might be. This can range from a short vacation away from the situation (with adequate help for the sufferer provided by someone else), joining a support group, or permanent placement in a facility equipped with doctors, nurses and other staff trained to deal with dementia patients. You can learn more at the Lewy Body Dementia Association website, www.LBDA.org.
Readers who are interested in learning more can order my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title when writing, or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
