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Elder CareTips:
Mastering The Eldercare Maze
August 15, 2006
Lewy Body Dementia is one of those
things that I hope none of you are experiencing or
caring for. But after you read the following I have
the suspicion that at least one out of four of you
will be questioning a diagnosis of Parkinson's Disease
or Alzheimer's Disease.
Looking back, I can see that many of the clients I
have worked with over the years probably had LBD. It
breaks my heart that we didn't know to look for LBD,
and in our ignorance we sometimes probably did more
harm than good.
Lewy Body Dementia
It's #2 Now
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Until recently vascular dementia
- the kind of brain deterioration caused by stroke -
was thought to be the second most common cause of
dementia (after dementia of the Alzheimer's type).
Researchers now believe that Lewy Body Dementia (LBD)
accounts for somewhere between 20 and 35 percent of
dementia cases. So Lewy Body Dementia has moved into
second place after Alzheimer's Disease, and few people
have even heard of it.
Studies are also showing that
many general practitioners don't recognize LBD, so
patients often go home with a diagnosis of AD or
Parkinsons Disease (PD) instead. Although at this
time Lewy Body Dementia is no more curable than are AD
or PD, it's important to know which of the three is
causing symptoms because there are important
differences in medication management.
To inconveniently complicate
things, Lewy Body Dementia can exist by itself or in
conjunction with other brain disorders, including
Alzheimer's Disease and Parkinson's Disease.
Why does it matter whether it's AD, PD or LBD?
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The medications used to treat
Parkinson's Disease can have strong adverse effects on
the cognitive/mental symptoms that Lewy Body Dementia
patients experience. And the psychiatric drugs used to
treat Alzheimer's disease can produce debilitating
Parkinson's-type symptoms. So, although we can never
know for sure while the patient is alive, it is
extremely important to have as accurate a diagnosis as
possible so we don't make the patient's final years
worse than they might have had to be.
Diagnosis of Lewy Body Disease
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An LBD patient usually first
visits the doctor with symptoms that could be mistaken
for Parkinson's Disease (or Parkinsonism):
hallucinations, short-term memory loss, sleep
disturbances and unpredictable personality and
cognitive swings.
In order to make a diagnosis of
"probable" Lewy Body Disease specialists will
generally look for a steady decline in cognitive
abilities plus two of the following. If only one of
the following is present, then the diagnosis is
usually "possible" Lewy Body Disease:
| Recurring visual
hallucinations; |
| Fluctuating (changing
irregularly) cognitive ability; |
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Memory loss |
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Decreasing judgment |
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Loss of initiative |
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Confusion regarding time and
place |
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Difficulty finding words and
completing tasks |
| Parkinson's-like symptoms; |
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Very slow movement or "frozen" posture,
shuffling gait |
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Muscle stiffness or rigidity |
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Poor balance, frequent falls |
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Tremor (resting tremor is less common) |
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Leaning or stooped posture, often to one
side |
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Blank facial expression |
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| In addition to the above many
patients with Lewy Body Disease are reported to
also experience: |
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Increased sensitivity to medications used to
treat psychiatric symptoms (neuroleptics); |
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Frequent falls, instances of fainting; |
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Difficulty with autonomic functions: blood
pressure, temperature regulation, urinary and
constipation issues; |
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Hallucinations of sound or taste, in
addition to the visual hallucinations mentioned
above; |
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Delusions; |
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Impaired sense of direction, depth
perception; |
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Weak voice and difficulty swallowing. |
Treatment of Lewy Body Disease
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Many patients have increased
sensitivity to the drugs that are prescribed for AD
and PD, making it difficult to treat the movement
symptoms and hallucinations without making one or the
other worse. Because there is no cure, medicine today
can only treat the symptoms of LBD. An experienced
neurologist or neuropsychiatrist should oversee care
if at all possible.
There is as yet no cure for Lewy
Body Dementia. Average duration is commonly 5 to 7
years, although some patients have lived much longer.
Onset is most usually between the ages of 50 and 85.
LBD appears to be slightly more common in men than in
women. Although researchers have not discovered any
genetic risk factors, there does appear to be a
slightly higher risk if a family member has had LBD.
Be careful about
reading health books. You may die of a
misprint."
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If you're caring for a
parent of the opposite sex and you occasionally get
out and about, the call of nature is bound to be heard
eventually.
Make or buy an
"Occupied" sign to hang on the restroom door when you
have to go into the "other" restroom to be of
assistance. You and your elder will be spared
embarrassment, as will other innocent restroom
visitors who might unintentionally interrupt you.
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Fosamax & Actonel:
Is Your Elder Hurting?
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A recent FDA article describes severe pain associated
with Fosamax (alendronate sodium) and Actonel
(risedronate sodium).
The article, which was published in the Archives of
Internal Medicine, describes over a hundred reports
received by the FDA of severe bone, joint and muscle
pain in patients being treated with Fosamax for
osteoporosis. Many patients were unable to walk, climb
stairs, or perform usual activities, and some of them
became bedridden. Many of them had numerous diagnostic
tests with mostly normal findings. If
your loved one is taking either of these medications
and is experiencing joint or muscle pain, print out a
copy of the article and pay a visit to the doctor.
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