Lewy body dementia includes two related conditions—dementia with Lewy bodies and Parkinson’s disease dementia. The difference between them lies largely in the timing of cognitive (thinking) and movement symptoms. In dementia with Lewy bodies, cognitive symptoms are noted within a year of parkinsonism (any condition that involves the types of movement changes seen in Parkinson’s disease). In Parkinson’s disease dementia, movement symptoms are most pronounced, with cognitive symptoms developing years later.
Dementia with Lewy Bodies
People with dementia with Lewy bodies first have a decline in cognitive skills that may look somewhat like Alzheimer’s disease. Over time they also develop movement and other distinctive symptoms that suggest dementia with Lewy bodies.
Symptoms that distinguish this form of dementia from others may include:
- visual hallucinations early in the course of dementia
- fluctuations in cognitive ability, attention, and alertness
- slowness of movement, difficulty walking, or rigidity (parkinsonism)
- sensitivity to medications used to treat hallucinations
- REM sleep behavior disorder, in which people physically act out their dreams
- more trouble with complex mental activities, such as multitasking, problem solving, and analytical thinking, than with memory
In his mid-sixties, Bruce started having some mild confusion and vivid dreams that he physically acted out by thrashing around and even falling out of bed. His neurologist diagnosed REM sleep behavior disorder and mild cognitive changes. Two years later, Bruce’s confusion had progressed to dementia. He was no longer able to live alone in his own home. His neurologist referred him for neuropsychological testing and, based on the results, changed his diagnosis to dementia with Lewy bodies.
Parkinson’s Disease Dementia
This type of LBD starts as a movement disorder, with symptoms such as slowed movement, muscle stiffness, tremor, or a shuffling walk. These symptoms lead to a diagnosis of Parkinson’s disease. Later on, cognitive symptoms of dementia and changes in mood and behavior may arise.
Not all people with Parkinson’s develop dementia and it is difficult to predict who will. Being diagnosed with Parkinson’s late in life is a risk factor for Parkinson’s disease dementia.
Betty is retired from the high school food-services department and is devoted to her family, especially her three granddaughters. At age 73, Betty developed a mild tremor in one hand, cramped handwriting, a shuffling gait, and a stooped posture. She was diagnosed with Parkinson’s disease. When she started having hallucinations 3 years later, her children became alarmed. Betty soon started having problems with confusion and visual-spatial orientation. She was diagnosed with Parkinson’s disease dementia.