What is Lewy Bodies Dementia? Dr. Domenico Pratico', MD, FCPP
- Dr. Domenico Pratico
- 3 days ago
- 4 min read
Lewy Body Dementia is an overlooked and often misunderstood clinical condition.
When we think of dementia, very often we think of Alzheimer’s disease since it is the most frequent cause of dementia in the elderly. However, Lewy body dementia (LBD) is another common type of progressive dementia, and one of the most complex to diagnose and manage.
LBD is a progressive disease, with symptoms starting slowly and worsening over time. In most cases they start at around age 50/55 or older, although it can affect also younger people.
Today we know that in individuals with this type of dementia there is a progressive accumulation of abnormal clumps of a protein called alpha-synuclein inside the nerve cells in certain areas of the brain involved in thinking, memory, and movement. We call these clumps “Lewy bodies" after the doctor who discovered and described them for the first time (Friedrich Heinrich Lewy in 1912).
In most cases, LBD is not inherited and manifest sporadically within a family as an isolated case. Today we know that there are certain genetic variants (DNA mutations) that increase the chance of developing the disease. These mutations can be inherited from the parents or may occur spontaneously.
However, we must reiterate that having a genetic variant does not mean that a person will develop the disease.
From a clinical point of view, the most common symptoms include:
• Visual hallucinations occur in up to 80% of people (early phase).
• Trouble with attention, planning, problem-solving, and reasoning.
• Unpredictable changes in concentration, alertness, and wakefulness.
• Movement changes, such as tremors or muscle stiffness, often referred to as “parkinsonism”.
• Sleep disorders, including rapid eye movement disorder, excessive sleep or lack of sleep.
• Memory problems (later phase).
Very often individuals with mild symptoms can function almost normally in their daily tasks. However, as the disease progresses, symptoms worsen and thinking and movement abilities decline, these subjects will need more help and may fully depend on caregiver’s attention.
There are two types of LBD — dementia with Lewy bodies and Parkinson's disease dementia — which are caused by the same underlying changes (deposits of Lewy bodies) in the brain.
Clinically, these conditions manifest similar symptoms, and the main difference seems to be the timing of symptoms onset.
In dementia with Lewy bodies, problems with thinking, changes in attention, and visual hallucinations develop early in relation to movement symptoms. The opposite is for Parkinson's disease dementia.
We must remember that not all patients with Parkinson’s disease will develop dementia.
DLB is often hard to diagnose early because symptoms may at first look like Alzheimer's or other mental illnesses such as psychosis or schizophrenia. Additionally, LBD can also occur alongside other forms of dementia in this case we refer to as “mixed dementia”.
For this reason, it is extremely important a very accurate anamnesis by talking to both the patient and family members or caregivers who can describe the best the changes, the signs and symptoms that have developed in recent time, including but not limited to thinking, movement, sleep, behavior, or mood.
Awareness matters, since early recognition helps avoid harmful treatments and allows better planning. To this end, in order for a physician to make an accurate diagnosis of LBD there are several important steps:
• Collect accurately the person’s medical history and symptoms.
• Physical exams and laboratory tests of blood and other fluids.
• Perform measures evaluating memory and other mental functions.
• Rule out other conditions that could cause similar symptoms by using blood tests and brain imaging tests.
Currently, LBD cannot be prevented or cured, however there are some measures and “treatments” that can help with some of the symptoms. In general, for a patient with LBD a treatment plan may involve medications to control the symptoms, physical and other types of therapy, and counseling. There are cases in which there is a need to make changes to the environment where the subject lives, making the home safer, other times the use of some equipment can make everyday tasks easier for the patient.
Social support is also very important. Support groups can be a valuable resource for people with LBD and their caregivers to share experiences and tips with others in the same situation. Nonprofit organizations and community organizations may provide online or in-person support groups.
I want to conclude this blog with a note of hope by saying that we, as researchers, are tirelessly working to better understand, to treat and/or prevent LBD.
Our goals are:
Develop better diagnostic tools, including biomarker tests (e.g., in cerebrospinal fluid, and blood) and specific brain imaging techniques.
Understand the differences between various forms of LBD, the underlying risk factors, and the relationship with other diseases like Alzheimer's.
Discover new treatments that target the underlying pathology, not just symptoms.
If you are interested in reading more of my blogs:
Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor at the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.
For more information on the research conducted by Dr. Domenico Pratico, please visit this link.
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Stay updated with the work happening at Dr. Domenico Pratico's lab by visiting the Pratico Lab website.
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