DIFFUSE LEWYBODY DISEASE

y neurodegenerative disorder that produces dementia, psychosis and abnormalities of movement  Dementia a general decline in cognitive abilities (thinking, memory, language, etc.) usually due to degeneration of the brain. second most common kind of dementia causes cognitive problems similar to those seen in Alzheimer's disease and motor problems like those in Parkinson's clinicians have limited ability to recognize this disorder, as the symptoms resemble Alzheimer s disease is currently incurable and it gets worse with time INCIDENCE y y about 10 to 15% of all diagnosed dementias are Lewy body type it is slightly more prevalent in men than in women

y y y y

HISTORY y 1912 O Frederick Lewydiscovered irregularities in the cells in the mid-brain region while examining the brains of people with Parkinson's disease O these abnormal structures (microscopic protein deposits found in deteriorating nerve cells) became known as Lewy bodies O since that time, the presence of Lewy bodies in the mid-brain has been recognized as a hallmark of Parkinson's disease. 1960s O researchers found Lewy bodies in the cortex of the brains of some people who had dementia known as cortical Lewy bodies or diffuse Lewy bodies O cortical Lewy bodies were thought to be rare 1980s O people recognized that Lewy body disease was more common than previously realized O people with Lewy body disease have Lewy bodies in the mid-brain region (like those with Parkinson's disease) and in the cortex of the brain. It's believed that they usually also have the "plaques and tangles" of the brain that characterize Alzheimer's disease. Conversely, it's believed that many people with Alzheimer's disease also have cortical Lewy bodies. O because of the overlap, it's likely that many people with Lewy body disease are misdiagnosed (at least initially) as having either Parkinson's disease or Alzheimer's disease.

DLBD vs. ALZHEIMERS DISEASE vs. PARKINSONS DISEASE Overlapping Symptoms of Parkinson s, Alzheimer s, and Lewy Body Disease Parkinson s and Lewy Body Disease Alzheimer s and Lewy Body Disease Some of the motor symptoms found in both Some of the cognitive symptoms found in Parkinson s and Lewy Body Disease's both Alzheimer's and Lewy Body's patients patients include: include: y Tremors y behavioral changes y muscle stiffness y decreased judgment y difficulties with balance y confusion and temporal/spatial disorientation y shuffling gait y difficulty following directions y stooped posture y decreased ability to communicate y slow movements y restless leg syndrome CAUSES y y y unknown Genetic genetic link with the PARK11 gene but not thought to be a hereditary disease with Alzheimer's Disease, DLBD risk is heightened with inheritance of the 4 allele of the apolipoprotein E (APOE)

PATHOPHYSIOLOGY
development of abnormal proteinaceous (alpha-synuclein) cytoplasmic inclusions, called Lewy bodies, throughout the brain

loss of acetylcholineproducing neurons (in the basal nucleus of Meynert and elsewhere)

loss ofdopamine-producing neurons (in the substantia nigra)

Cerebral atrophy

When Lewy bodies reaches the cortex, DLBD concomitants with Alzheimer s disease

Hippocampus is affected with senile plaques (deposited beta-amyloid CHON) and granulovacuolar degeneration (grainy deposits within, and a clear zone around hippocampal neurons.

DIAGNOSIS People with Lewy body disease have cognitive problems (problems with thinking, memory, language, etc.) similar to those that occur in Alzheimer's disease. Therefore, it can be hard to distinguish the two. Some doctors think there are three distinguishing features and the presence of two of them makes the diagnosis of Lewy body disease probable: 1. Motor problems typical of Parkinson's disease but usually not so severe as to warrant a diagnosis of Parkinson's. y y y y shufflinggait muscle stiffness more prone to falls tremors, but less common

2. Fluctuations in cognitive function with varying levels of alertness and attention. y Periods of being alert and coherent alternate with periods of being confused and unresponsive to questions

3. Visual hallucinations and delusions It's possible that people with Lewy body disease are better able to form new memories than those with Alzheimer's disease. Compared with Alzheimer's, Lewy body disease may affect speed of thinking, attention and concentration, and visual-spatial abilities more severely than memory and language. Depression may be a typical symptom too. SIGNS AND SYMPTOMS y y Mental decline Lewy Body patients may experience reduced alertness and lowered attention span. Recurrent visual hallucinations or depression hallucinations, usually related to people or animals

y y y y y

Increasing problems handling the tasks of daily living tasks that used to be simple may become difficult for a person with Lewy Body dementia Repeated falls and sleep disturbances this includes insomnia and acting out dreams Fluctuations in autonomic processes this includes blood pressure, body temperature, urinary difficulties, constipation, and difficulty swallowing Orthostasis including repeated falls, syncope (fainting), and transient loss of consciousness Hypersensitivity to neuroleptic and antiemetic medications that affect dopaminergic and cholinergic systems a patient treated with these drugs could become catatonic, lose cognitive function and/or develop life-threatening muscle rigidity ex: chlorpromazine, haloperidol, or thioridazine

TREATMENT and MANAGEMENT y y Symptom management Pharmacologic: O Drugs to treat four major features found in Lewy body disease:     Cognitive problems Aricept; it slows the progression of the disease Motor problems Levodopa/Carbidopa (Sinemet); may worsen hallucinations, though Hallucinations Zyprexa; this kind of medication can worsen motor problems, though Depression Zoloft or Prozac

O Neuroleptics (strong tranquillizers) usually given to people with severe mental health problems particularly dangerous as this class of drugs induce Parkinson-like side-effects; must be done with the utmost care, under constant supervision, and should be monitored carefully and regularly.  According to Lewy Body Dementia Association: Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome (NMS), which can be fatal. (NMS causes severe fever, muscle rigidity and breakdown that can lead to kidney failure.)

Nursing Care:

O Create a routine it may help people with Lewy Body dementia to have predictable routines, especially around meal times and sleep times. O Establish a nighttime ritual try to establish bedtime rituals that are calming and away from the noise of television, meal cleanup and active family members. Limit caffeine, discourage napping and encourage exercise. O Modify tasks break tasks into easier steps and focus on success, not failure. O Walk together taking a walk with the patient with LBD is a win-win activity. Being outdoors and exercising is vital for health and state of mind for both of you. O Strengthen senses have a doctor evaluate each the patient s five senses in order to identify and treat any abnormalities. Then ask about exercises to improve them. O Make behavioral changes to help minimize the risk of fall-related injuries, stabilize blood pressure. Stay well hydrated,exercise,take in adequate sodium (salt),avoid prolonged bed rest,andstand up slowly.

Sources: http://www.lewybodyjournal.org/whatlbdis.html#dementia http://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies http://helpguide.org/elder/lewy_body_disease.htm http://www.lbda.org/category/3437/what-is-lbd.htm

http://www.alzbrain.org/pdf/handouts/4001.%20DIFFUSE%20LEWY%20BODY%20DISEASE.pdf