By Stephen Des Georges
Desert Haven Home Care and Apollo Residential Assisted Living provides residents with high-quality supervision and treatment reflective of its proprietary three cornerstones of managed care for seniors: meaningful, patient-centered care, best-class service and passionate advocacy. Healthcare professionals at each residence are knowledgeable and respected servants, familiar with the latest evidence-based research and outcomes. It is our privilege to regularly share with you timely and topical insights into issues that impact elderly loved ones. In this installment, Lewy body dementia, a debilitating brain disorder, is reviewed, including its causes and treatments.
On July 21, 2021, actor and comedic genius Robin Williams would have turned 70. Williams not only amplified and brought awareness to the life-changing, prevalent disease known as Lewy body dementia, but his passing brought much needed attention to the importance of mental health and the non-movement symptoms of depression and anxiety that can accompany a neurodegenerative disease.[1]
Understanding and coping with a dementia diagnosis can be overwhelming, but you’re not alone; nearly 50 million people worldwide have been diagnosed with a form of dementia, according to the World Health Organization. Among those 50 million are more than million suffering from cortical Lewy body disease or diffuse Lewy body disease, also known as Lewy body dementia.
What is Lewy body dementia?
Lewy body dementia (LBD) is a common type of dementia affecting the elderly population in assisted care – Alzheimer’s is the most common dementia, LBD the second most common. Studies have shown this type of dementia to be detected in more than one million individuals in the United States, with the majority of those belonging to mature adults age 50 and older. LBD is a degenerative condition with many similarities to Alzheimer's disease, but it takes hold much more quickly. Dementia develops as nerve cells die or deteriorate, although scientific research has yet to determine the cause or causes of such degradation.
How is Lewy body disease different from other forms of dementia?
Lewy Body Dementia is a type of progressive degenerative disorder of the brain, which is mainly characterized by forgetfulness, psychosis and characteristics similar to Parkinson's disease. LBD can be divided into two subcategories: Parkinson's disease dementia and dementia with Lewy bodies. LBD is a syndrome associated with abnormal deposits of a protein called alpha-synuclein. These deposits are known as Lewy bodies. The result of these deposits is a progressive degenerative brain disorder characterized by dementia, psychosis, and features of parkinsonism.[2] These α-synuclein- and ubiquitin-positive bodies are the indicators of LBD and Parkinson’s disease, as well as numerous other neurodegenerative diseases. The regulation of α-synuclein and ubiquitin, and their part in Lewy body formation and brain degeneration, continue to be unclear.[3]
The symptoms of LBD
The general symptoms associated with Lewy body dementia tend to develop gradually, presenting with a subtle onset. These include:[4]
Hallucinations
Fluctuating confusion
Difficulty of sleep
Inability to pay attention
Apathy (drowsiness)
Impairment of cognition
Depression
Risk factors of LBD
The common risk factors associated with Lewy body dementia include a family history of LBD, male gender and, especially, advanced age. The major cause of the development of Lewy body dementia is a reduction in the levels of acetylcholine in the brain – why a reduction occurs has yet to be discovered by researchers. Acetylcholine is an organic chemical in the brain that functions as a neurotransmitter, required for the healthy functioning of the body. Experts believe that the reduction of acetylcholine levels in certain parts of the brain is what causes the visual hallucinations and delusions associated with Lewy body dementia, while the reduction in dopamine levels – the body manufactures dopamine, the nervous system uses it to send messages between nerve cells – leads to significant mood changes.
Diagnosing LBD
Says Mayo Clinic:
“A diagnosis of Lewy body dementia requires a progressive decline in your
ability to think, as well as at least two of the following:
Fluctuating alertness and thinking function
Repeated visual hallucinations
Parkinsonian symptoms
REM sleep behavior disorder, in which people act out their dreams during sleep
No single test can diagnose Lewy body dementia. The diagnosis is based
the on signs and symptoms you have and ruling out other conditions that
can cause similar signs and symptoms.”[5]
Additionally, Mayo Clinic notes:
“Autonomic dysfunction, which involves instability in blood pressure
and heart rate, poor regulation of body temperature, sweating and
related signs and symptoms, supports a Lewy body dementia diagnosis.
So does sensitivity to antipsychotic drugs, particularly first-generation
antipsychotics such as haloperidol (Haldol). Medications like Haldol
aren't used for people with Lewy body dementia because they can cause
a severe reaction.”[5]
Treatment of LBD
The two major forms of management for Lewy Body Dementia of the elderly include:
Nonpharmacological approaches
The common recommended nonpharmacological approaches for Lewy Body Dementia include thorough education of the patient, their family, and caregiver along with reassuring and explaining any questions they may have regarding the condition. The health professional may also introduce memory prompts, attention cues, and behavioral interventions for the patient as critical parts of the management of this Dementia.
Pharmacological approaches
Levodopa: Levodopa is one of the recommended medications for Lewy body dementia; however, it should be used in lower doses in order to avoid hallucination and confusion in the elderly population.[6] It works by being converted to dopamine in the brain.[7]
Anti-Cholinesterase: Multiple clinical trials have shown anti-cholinesterase drugs to be much safer for the treatment of Lewy body dementia, and have been found to be effective for the associated neuropsychiatric and cognitive symptoms.[8]
Conclusion
Even though the frequency of Lewy body dementia in the elderly population in many states of the U.S., like Arizona, has increased over the past few years, its diagnosis is not as straightforward. This is because these forms of dementia in the elderly in assisted living situations are usually associated with numerous overlapping pathologies, and sometimes its early diagnosis may be missed altogether. Hence, care homes for the elderly and assisted living services should carry out tests and screening on the elderly individuals more frequently in order to allow more efficient management of the condition.
At Desert Haven Home Care and Apollo Residential Assisted Living in Greater Phoenix, Arizona, professional healthcare team members are on hand to make certain the proper treatments for dementia are always in place and constantly practiced. Team members know the symptoms of the syndrome, including Lewy body dementia, and are prepared to ensure all appropriate measures are taken to ensure the good health and comfort of their residents.
Among the foundations of our care, as endorsed by the Alzheimer’s Association Campaign for Quality Residential Care, are:
Quality relationships shared with residents by professional team members; a supportive environment
Assessment of each resident’s abilities for proper acre and planning; recognition of special needs
Person-focused strategies; working with residents to ensure the best-possible quality-of-life results
Meaningful, daily social interactions
Formal and informal activities that provide personal meaning and sense of community and choices.
For more information about Desert Haven Home Care and Apollo Residential Assisted Living, visit www.deserthavenaz.com.
References
[1] Robin Williams Would Have Been 70 This Year, Here's What We Know About Lewy Body Dementia, Suicide and Parkinson's. Parkinson’s Fundation. 2021. https://www.parkinson.org/blog/awareness/robin-williams-lewy-body-dementia-suicide-pd?utm_source=google&utm_medium=adgrant&utm_campaign=&utm_term=lewy%20body%20dementia%20robin%20williams&gclid=Cj0KCQiAzfuNBhCGARIsAD1nu-9RL50zMUThq4xewZ6P-6AISm3ixdhTK-VMsOOdI7F1XX8aVk08CpoaAnuLEALw_wcB.
[2] Galvin, J.E., Balasubramaniam, M. Lewy Body Dementia: The Under-Recognized but Common Foe. Cerebrum, 2013;2013: 13. Published 1 Oct. 2013.
[3] Haider A., et. al. Lewy Body Dementia. [Updated 12 July 2021]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482441/.
[4] Lee, J.T., et. Al. Ubiquitination of α-synuclein by Siah-1 promotes α-synuclein aggregation and apoptotic cell death. Human Molecular Genetics, Vol. 17, Issue 6, 15 March 2008, Pages 906–917, https://doi.org/10.1093/hmg/ddm363.
[5] Outeiro, T.F., et al. Dementia with Lewy bodies: an update and outlook. Mol Neurodegeneration, 14, 5 (2019). https://doi.org/10.1186/s13024-019-0306-8.
[6] Lewy body dementia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/diagnosis-treatment/drc-20352030
[7] Burn, David J., and Ian G. McKeith. "Current treatment of dementia with Lewy bodies and dementia associated with Parkinson's disease." Movement disorders, Vol. 18, Suppl 6 (2003): S72-9. doi:10.1002/mds.10566.
[8] American Society of Health-System Pharmacists, Inc. (2021). Levodopa and Carbidopa. https://medlineplus.gov/druginfo/meds/a601068.html#:~:text=Levodopa%20is%20in%20a%20class%20of%20medications%20called,being%20broken%20down%20before%20it%20reaches%20the%20brain.