Silver Age Health | Irreversible disease - Lewy body dementia

When we talk about dementia, we tend to think of Alzheimer's disease, but dementia is not limited to Alzheimer's disease. There is another type of dementia: Lewy body dementia.

| What is Lewy Body Dementia

Lewy body dementia is a mental retardation syndrome characterized by fluctuating cognitive impairment, recurrent visual hallucinations, and spontaneous Parkinson's syndrome, accounting for 10% to 20% of the causes of dementia, second only to Alzheimer's disease. It usually occurs in people aged 50 to 80, more commonly in men, and the course of the disease is generally 5 to 7 years.

Patients with Lewy body dementia have a more significant decline in quality of life, a heavier care burden, and higher overall costs. In addition, they are highly sensitive to neuroleptics, so early diagnosis and appropriate treatment are required.

Causes

Dementia with Lewy bodies is caused by abnormal proteins called Lewy bodies that build up in brain cells. These deposits are also found in the brain cells of some people with Parkinson's disease, where the brain cells responsible for memory and muscle movement are primarily affected. Scientists don't know exactly why these deposits occur or how they damage brain cells, but one theory is that the condition affects the signaling between brain cells. There is no family history of dementia with Lewy bodies, but there are some reports of rare cases of the condition running in families.

▏Symptoms of Lewy body dementia

Core symptoms:

1. Fluctuating cognitive impairment

Lewy body dementia is characterized by a comprehensive decline in cognitive function, often with memory loss and disorientation. Early memory impairment is mild and fluctuating, and may also be accompanied by aphasia, apraxia and agnosia. Some patients have decreased attention, decreased vigilance and lack of fluency in language. Cognitive impairment fluctuates and can change significantly within a few weeks or even within a day, with alternating abnormal and normal states, sometimes mild and sometimes severe.

2. Recurrent visual hallucinations

The most common core symptom, about 80% of patients have visual hallucinations. They often appear in the early stages of the disease and do not disappear as the disease progresses. They are complete in form, specific in content, and can occur repeatedly. The objects are often people, animals, machines, etc. that the patient is familiar with. They are vivid and vivid, and the patient can describe them vividly. There are also mental abnormalities such as delusions, delirium, and agitation, and they are very sensitive to neuroleptics and antipsychotics.

3. Extrapyramidal movement disorders

Lewy body dementia often presents with Parkinson's syndrome, such as rigidity, decreased movements, and bradykinesia. Extrapyramidal symptoms may occur simultaneously with cognitive impairment or one after the other. The occurrence of the two groups of symptoms within one year is diagnostically significant. Patients with Lewy body dementia may experience myoclonus, autonomic dysfunction, dystonia, etc., often fall, faint, and even have transient loss of consciousness.

Associated symptoms:

1. Sleep behavior disorder

It can manifest as sudden, usually large-scale motor behaviors during sleep, accompanied by vivid dreams with varying contents. The most common behaviors are swinging arms and hitting, kicking, talking, shouting, and getting up in bed. Grinding of teeth, laughing, singing, and walking at night may also occur. It is easy to be awakened between attacks, and there is no clouding of consciousness after waking up. The patient's dreams are usually vivid and full of violent activities, and there are often experiences of anger and fear.

2. Autonomic dysfunction

Constipation is the most common and orthostatic hypotension is the most serious; other symptoms include decreased sweating, heat intolerance, urinary incontinence, and sexual dysfunction.

3. Highly sensitive to neuroleptic drugs

Patients taking neuroleptics may experience symptoms such as slow movements, body stiffness, and tremors.

4. Personality changes

It manifests as apathy, depression, or increased aggressiveness.

▏Criteria for diagnosis of Lewy body disease

1. Necessary symptoms, including:

(1) Cognitive impairment: persistent cognitive decline that affects social and occupational functions.

(2) Prominent or persistent memory impairment, which does not necessarily occur early but is usually progressive.

(3) The executive function of attention declines, and the changes in visual spatial ability are more prominent.

2. Core symptoms, including:

(1) Fluctuating cognitive impairment.

(2) Visual hallucinations.

(3) Parkinson's syndrome.

3. Suggestive symptoms, including:

(1) Abnormal rapid eye movement sleep behavior.

(2) Nervous tissue and hypersensitivity.

(3) Pat suggested that dopamine transporter uptake was reduced in the basal ganglia.

4. Support symptoms, including:

(1) Repeated falls or fainting.

(2) Brief, unexplained loss of consciousness.

(3) Severe autonomic dysfunction, such as orthostatic hypotension and urinary incontinence.

(4) Other forms of hallucinations.

(5) Delusion.

(6) Depression.

(7) Neuroimaging CT or MRI shows relative preservation of the medial temporal lobe structure.

(8) Pat showed decreased function of the occipital visual cortex, and the electroencephalogram showed brief intermittent slow wave activity in the temporal lobe.

▏Seeking medical treatment

When elderly people suddenly experience abnormal symptoms such as hallucinations, illusions, sudden disorientation, slow movements, etc., especially if these symptoms appear and disappear from time to time, they need to seek medical attention promptly.

Treatment

1. Drug treatment

There is currently no specific treatment for Lewy body dementia, and symptomatic treatment is mainly through medication. Due to large individual differences, there is no absolutely best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, the most suitable medication should be selected under the guidance of a doctor and fully combined with personal circumstances.

2. Cognitive training

Mild and moderate patients can undergo cognitive stimulation training to help improve memory ability.

3. Physical therapy

Simple aerobic exercise can be performed, which is very helpful for maintaining the patient's mobility and can also prevent and alleviate cognitive decline. At the same time, non-conventional treatments such as dietary nutrition management and disease knowledge education for patients and families can be strengthened.

Prognosis

1. Curative

The neurological lesions of Lewy body dementia are irreversible and the prognosis is poor. The only thing we can do is to delay the progression of the disease as much as possible, and the specific speed varies from person to person.

2. Severity

In the later stages of the disease, death may occur due to a variety of complications, and life expectancy is 5 to 7 years, which is shorter than that of Alzheimer's disease.

▏Daily

The daily life management of this disease focuses on maintaining a good living environment, including maintaining good daily habits and careful care from family members.

Since the cause of Lewy body dementia is unknown, the only way is to detect, diagnose and treat it as early as possible to delay the progression of the disease, improve the patient's quality of life and prolong the patient's life.

Home Care

1. When communicating with patients, maintain eye contact, speak slowly, use simple sentences, and only ask one question or instruction at a time. Do not rush for a response from the patient. You can also use gestures to assist.

2. Encourage and accompany patients to do simple exercises, and encourage them to participate in activities that require thinking, such as playing chess, reading, and playing games.

3. Pay attention to creating a quiet sleeping environment at night. If the patient has the habit of getting up at night, you can add a night light to prevent him from getting lost.

(Picture from the Internet)

Author | Li Aiping was born in Qiqihar, Heilongjiang Province. She graduated from Fuzhou Medical University and has 20 years of nursing experience. She is a national second-level nurse. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.