This is a nice, short description of LBD that utilizes the explanation on the LBDA website (lbda.org) about the three possible presentations of LBD -- dementia first, Parkinson's first, or psychiatric problems (hallucinations, etc) first. This description is posted to the WTVQ television station website in Lexington, KY.
There's a short (2 minute?) video that aired on Wednesday. The physician in the video is James Galvin, MD. He's on the LBDA's Scientific Advisory Council. He's based in NY so I'm not sure why a KY TV station is interviewing him!
Lewy Body Dementia
WRITTEN BY KRISTI RUNYON
WEDNESDAY, 02 FEBRUARY 2011 11:53
Lewy Body Disease is the second leading cause of brain degeneration. Because symptoms include Parkinsonâs-like slowness and memory loss, it is often mistaken for these other disorders.
Lewy bodies are a kind of abnormal protein in the brain. Formation of the deposits is associated with a decrease in a brain chemical, dopamine, which is responsible for smooth, coordinated movement. When the deposits are confined to the brain stem, patients develop symptoms of Parkinsonâs disease.
In Lewy body dementia (LBD), the abnormal proteins are found throughout the brain. In these other brain areas, the protein deposits cause depletion of acetylcholine, a brain chemical needed for perception, cognitive thought and control of behaviors.
The term, LBD, typically refers to one of two different conditions, based on how the symptoms first appear. In dementia with Lewy bodies, patients initially have problems with memory or thought. The symptoms are similar to those seen in Alzheimerâs patients. Eventually, however, patients who have dementia with Lewy bodies develop characteristic changes in attention, alertness, cognitive ability, movement problems, hallucinations and sensitivity to certain medications. Patients also develop a sleep condition, called REM sleep disorder, in which they act out in their dreams (like punching, kicking, etc.).
The second group of patients with LBD initially starts out with Parkinson-like movement problems. This is called Parkinsonâs disease dementia. These patients eventually develop memory and cognitive problems, hallucinations and other signs associated with LBD.
A very small number of patients with LBD will initially have hallucinations, behavior problems and trouble with complex thought processes. These patients are the most likely to receive an accurate initial diagnosis.
The Lewy Body Dementia Association estimates about 1.3 million Americans have LBD. The condition is most common in older people, with symptoms most commonly appearing between 50 and 85. Men are affected more often than women. Family history also appears to play a role in risk for LBD. Generally, patients live for about 7 years after diagnosis.
Getting a Diagnosis
James Galvin, M.D., Neurologist with NYU Langone School of Medicine in New York City, says many physicians are unfamiliar with LBD. Since the symptoms are similar to Alzheimerâs and Parkinsonâs disease (depending upon the initial presentation), misdiagnosis is common. However, itâs important to have an accurate diagnosis because some medications work better for LBD. In addition, Galvin says certain medications used to treat behavioral symptoms can increase movement problems in patients with LBD and, in severe cases, cause high fever, serious muscle rigidity, muscle breakdown, kidney failure and death.
Galvin recommends that a close family member be present during a patientâs evaluation. Often patients, themselves, arenât aware of/or understand the severity of their symptoms. Most donât remember acting out during REM sleep.
The NYU-Langone Lewy Body Disease Center was created specifically to help patients with LBD. Galvin says the center will serve as a central repository for information and diagnostic expertise. Families and physicians can get assistance over the phone on any day of the week. Eventually, there will be a website with information and resources. The center also provides support and therapy for caregivers and family members. Galvin adds, the center also provides a large pool of patients for doctors to draw from for clinical trials to test new diagnostic tools and treatments.
For information on Lewy Body Dementia:
Lewy Body Dementia Association, http://www.lbda.org
National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov
Lim, Seok Ming, et al., âThe 18F-FDG PET Cingulate Island Sign and Comparison to 123I-Beta-CIT SPECT for Diagnosis of Dementia with Lewy Bodies,â The Journal of Nuclear Medicine, October 2009, Vol. 50, No., 10, pp. 1638-1645.
Nelson, Peter, et al., âLow Sensitivity in Clinical Diagnoses of Dementia with Lewy Bodies,â Journal of Neurology, March 2010, Vol. 257, No. 3, pp. 359-366.
Nervi, Angela, M.D., et al., âComparison of Clinical Manifestation in Familial Alzheimerâs Disease and Alzheimerâs Disease and Dementia with Lewy Bodies,â Archives of Neurology, December 2008, Vol. 65, No. 12, pp. 1634-1639.
Watson, Rosie, et al., âMagnetic Resonance Imaging in Lewy Body Dementias,â Dementia and Geriatric Cognitive Disorders, 2009, Vol. 28, No. 6, pp. 493-506.
Research compiled and edited by Barbara J. Fister
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