Lewy Body Disease

(Lewy Body Dementia; Dementia with Lewy Bodies)

Definition

Dementia is the progressive loss of memory and various other mental functions, including the ability to learn, reason, and judge. Lewy body disease is associated with the build up of Lewy bodies in regions of the brain. These are abnormal protein deposits inside cells that control certain aspects of memory and motor control.

Brain Cells

Causes

It is not clear exactly what causes the build up of Lewy bodies in the brain. But the disease is linked to:

Parkinson's disease
Multiple system atrophy
Alzheimer's disease
Other disorders

Risk Factors

Factors that can increase your chance of developing Lewy body disease include:

Gender: male
Age: 53-83 years
Family history of Lewy body disease, Parkinson's disease, or other dementias

Symptoms

Lewy body disease is characterized by:

Fluctuations in alertness and attention—frequent drowsiness, lethargy, staring into space, disorganized speech, and insomnia
Recurrent visual hallucinations
Poor regulation of body temperature and blood pressure
Obsessive compulsive behaviors
Forgetfulness
Parkinsonian motor symptoms—rigidity, loss of spontaneous movement
REM behavior disorder

Diagnosis

The only way to diagnose Lewy body disease is through an autopsy . A doctor can do tests to narrow the cause of dementia. You will be asked about your symptoms and medical history. A physical exam will be done. Other tests may include:

Memory, language, and other tests
Neuropsychological tests
Patient and family interviews
You may need to have pictures taken of your bodily structures. This can be done with:
- CT scan
- MRI scan
- SPECT scan
You may need to have your bodily fluid tested. This can be done with blood tests.

Treatment

While there is no cure for Lewy body disease, there are treatments that can control the symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

These medicines may be used to help with the symptoms:

Donepezil and rivastigmine—to help with cognition; may worsen motor symptoms
Memantine—to improve behavioral symptoms
Levodopa—to help control rigidity and loss of spontaneous movement
Antidepressants
Anticonvulsants

If you have Lewy body disease, you may be sensitive to medicines called neuroleptics. You may have adverse events with these medicines.

Other Treatments

You may benefit from:

Physical therapy
Massage
Exercise
Music
Aromatherapy

Prevention

There is no known way to prevent this condition.

RESOURCES

Lewy Body Dementia Association http://www.lewybodydementia.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Alzheimer Society http://www.alzheimer.ca

Canadian Stroke Network http://www.canadianstrokenetwork.ca

References

Ballard CG, Chalmers KA, Todd C, et al. Cholinesterase inhibitors reduce cortical Abeta in dementia with Lewy bodies. Neurology . 2007;68:1726-1729.

Bouchard RW. Diagnostic criteria of dementia [review]. Can J Neurol Sci . 2007;34:(Suppl 1)S11-18.

Camicioli R, Gauthier S. Clinical trials in Parkinson's disease dementia and dementia with Lewy bodies [review]. Can J Neurol Sci . 2007;34:(Suppl 1)S109-117.

Chou KL, Borek LL, Friedman JH. The management of psychosis in movement disorder patients [review]. Expert Opin Pharmacother . 2007;8:935-943.

Dementia with Lewy bodies. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated September 11, 2012. Accessed February 21, 2013.

Dementia with Lewy bodies information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/dementiawithlewybodies/dementiawithlewybodies.htm . Updated May 16, 2012. Accessed February 21, 2013.

Emre M, Tsolaki M, Bonnucelli U, et al. Memantine for patients with Parkinson’s disease dementia or dementia with Lewey bodies: a randomised, double-blind, placebo controlled trial. Lancet Neurol . 2010;9(10):969-77.

Goldmann Gross R, Siderowf A, Hurtig HI. Cognitive impairment in Parkinson’s disease and dementia with Lewy bodies: a spectrum of disease. Neurosignals . 2008;16:24-34.

Jellinger KA. Formation and development of Lewy pathology: a critical update. J Neurol . 2009;256(Suppl 3):270-279.

Kemp PM, Hoffmann SA, Tossici-Bolt L, Fleming JS, Holmes C. Limitations of the HMPAO SPECT appearances of occipital lobe perfusion in the differential diagnosis of dementia with Lewy bodies. Nucl Med Commun . 2007;28:451-456.

Lewy body disease: LBD. Lewy Body Disease Association website. Available at: http://lbda.org/sites/default/files/booklet-for-newly-diagnosed-patients2.pdf . Accessed February 21, 2013.

Meeus B, et al. The genetics of dementia with Lewy bodies: what are we missing? Arch Neurol . 2012;69(9):1113-8.

Tarawneh R, Galvin JE. Distinguishing Lewy body dementias from Alzheimer’s disease. Expert Review of Neurotherapeautics . 2007;7:1499-1516.

Weintraub D, Hurtig HI. Presentation and management of psychosis in Parkinson’s disease and dementia with Lewy bodies. Am J. Psychiatry . 2007;164:1491-1498.

Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 03/2013
Update Date: 03/15/2013

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.