Lewy body dementia

Lewy body dementia: protein particles in the brain

Lewy body dementia (Lewy body dementia or Lewy body dementia) is a form of dementia that causes symptoms similar to Alzheimer’s and Parkinson’s.

In those affected, characteristic inclusions in the nerve cells of the cerebral cortex lead to the various symptoms. These inclusions (called Lewy bodies) are protein residues (from alpha synuclein) that are not degraded properly.

Such Lewy bodies are also found in the brain of Parkinson’s patients, but in another area (brainstem).

In the brain of people with Lewy body dementia, Alzheimer’s plaques are usually also found, another type of protein deposits. Conversely, in Alzheimer’s disease, there is a variant in which the sufferers have Lewy bodies in the brain in addition to the plaques. This disease variant is difficult to distinguish from Lewy body dementia.

Lewy body dementia: frequency

Estimates of the prevalence of Lewy body dementia vary widely. Often the disease is not recognized and misdiagnosed. Studies suggest that about 15 percent of dementia patients in hospitals suffer from Lewy Body dementia. In the general population, an estimated 10 to 12 percent of people are affected. Men fall more frequently in this form of dementia than women.

Lewy body dementia: symptoms

Lewy body dementia is an early onset optical hallucinations on – the affected so see something that is not there at all (usually people or larger animals). Rarely does it happen too acoustic hallucinations: Patients do not hear voices, music or sounds.

On antipsychotics (neuroleptics), which can actually alleviate such psychotic symptoms, people with Lewy body dementia are generally hypersensitive. This is called “neuroleptic sensitivity”.

Also typical for the Lewy body dementia is that the mental and physical condition of patients varies greatly, Especially the attention and the alertness vary considerably and fast during the course of the day – sometimes the patients are completely alert and active, then suddenly introverted, confused and disoriented.

Compared to Alzheimer remains in the Lewy body dementia the Keep memory longer, Nevertheless, the memory disorder progresses.

The disease typically goes along Behavioral disorders in dream sleep (REM sleep phase): Due to a lack of motor inhibition patients actually live out their dreams. You can, for example, scream, talk and / or move in your sleep.

Many patients with Lewy body dementia show Parkinson’s symptoms, These include increased stiffness (rigor), shaky hands (tremor), slowing movement (akinesia), diminishing facial expression (hypomnia), and walking in small increments. Patients are often unsure when walking and fall easily. Sometimes they tend to go to one side of the body when walking and standing (Pisa syndrome).

Some patients fall into one for days deep Sleep, It also develops a large proportion of patients depressions.

Other possible symptoms of Lewy body dementia are low blood pressure getting up and sitting for longer as well urinary incontinence. impairments the language occur only in the later course of the disease.

In the final stage often develop dysphagia.

Lewy body dementia: causes and risk factors

Why some people develop Lewy Body dementia is not well known. In some families, the disease can be traced back to changes in the genome. The same genes are pathologically altered as in classic Parkinson’s disease.

So far, no risk factors for Lewy body dementia are known.

Lewy body dementia: examinations and diagnosis

Lewy body dementia is diagnosed on the basis of symptoms and by excluding other conditions with similar symptoms. As is generally the case with suspected dementia, the medical history is recorded (anamnesis), a physical examination and dementia tests are carried out.

Apparative examinations are not helpful in the diagnosis of Lewy body dementia: the measurement of brain waves (electroencephalography, EEG) as well as imaging by computer tomography (CT) and magnetic resonance imaging (MRI) revealed no characteristic findings in Lewy body dementia , Such examinations are only carried out to exclude other diseases (such as brain tumors).

Specialized forms of computed tomography (PET, SPECT) can help differentiate Lewy body dementia from other types of dementia.

So far, there are no laboratory tests of a blood sample or a sample of the cerebro-spinal fluid (CSF), with which the Lewy Body dementia can be detected.

Lewy body dementia: treatment

Various medications can be used to alleviate the symptoms of Lewy body dementia. However, none of these preparations is specifically approved for the treatment of this form of dementia. They are used individually in “off-label use” (application without authorization).

From the group of so-called anti-dementia drugs can Cholinesterase relieve the psychotic symptoms of Lewy Body dementia patients. Among other things, such symptoms are due to a lack of neurotransmitters acetylcholine in the brain. Cholinesterase inhibitors (such as rivastigmine) block the breakdown of the messenger substance, allowing it to take longer to take effect. The drug may also help with the behavioral symptoms memantineanother anti-dementia drug.

Sometimes psychotic symptoms can not be managed with cholinesterase inhibitors. Then, with great caution, the antipsychotics Be given quetiapine or clozapine. They are usually tolerated in Lewy body dementia – unlike other antipsychotics, which should therefore not be given.

Antiparkinsonian drugs (like L-Dopa) usually do not work so well in patients with Lewy Body dementia. In addition, these supplements can increase the psychotic symptoms. If L-dopa is prescribed, then usually in low or medium doses. The active ingredient is then generally better tolerated than in higher dosage.

So-called depression helps SSRI (Selective serotonin reuptake inhibitors such as citalopram).

Non-drug treatment

Since the drug treatment of Lewy Body dementia is difficult, the non-drug therapy measures are of great importance. Suitable are the same procedures as in Alzheimer’s disease, ie, for example, memory training, occupational therapy, physiotherapy, behavioral therapy, music and art therapy. Which of these non-drug therapeutic measures are most appropriate in the individual case, is decided individually and in consultation with the patient.

Lewy body dementia: history and prognosis

The Lewy body dementia is not curable so far. The symptoms usually appear only after the age of 65. After diagnosis, the disease duration is on average seven to eight years. Most patients with Lewy body dementia die from pneumonia.