What Is Dementia With Lewy Bodies
Dementia with Lewy Bodies may account for 10-15 per cent of all cases of dementia. DLB can be diagnosed wrongly and is often mistaken for Alzheimers disease.
DLB is sometimes known by other names. These include Lewy body dementia, Lewy body variant of Alzheimers disease, diffuse Lewy body disease and cortical Lewy body disease. All these terms refer to the same condition.
What a short video about dementia with Lewy bodies:
Where To Go For Support
For further support and advice on living with dementia with Lewy bodies, or caring for someone with the condition, you can contact The Lewy Body Society on 01942 914000 or by email at
If you have questions about dementia, dementia research or would like to take part in research studies, please contact the Dementia Research Infoline 0300 111 5111 or email
What To Do If You Suspect Alzheimers Disease
Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimers disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.
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Vascular Contributions To Alzheimers Disease
People with dementia seldom have only Alzheimers-related changes in their brains. Any number of vascular issuesproblems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis , and mini-strokesmay also be at play.
Vascular problems may lead to reduced blood flow and oxygen to the brain, as well as a breakdown of the blood-brain barrier, which usually protects the brain from harmful agents while allowing in glucose and other necessary factors. In a person with Alzheimers, a faulty blood-brain barrier prevents glucose from reaching the brain and prevents the clearing away of toxic beta-amyloid and tau proteins. This results in inflammation, which adds to vascular problems in the brain. Because it appears that Alzheimers is both a cause and consequence of vascular problems in the brain, researchers are seeking interventions to disrupt this complicated and destructive cycle.
How Alzheimers Disease Affects The Brain
Everyone who cares for someone with Alzheimer’s disease knows all too well that this condition is a thief who slowly steals the most precious parts of those they love. Their memories, ability to communicate, self expression, thinking and planning skills, and personality transform, fade, or eventually disappear.
Caring for someone throughout the stages of AD can leave caregivers feeling powerless, unprepared, and frustrated. Understanding how the disease affects the brain can help caregivers know more about what to expect as it progresses and how to prepare for the later stages. Reducing the amount of surprise involved can make this process less stressful and help caregivers to better look after themselves and their loved ones.
Remember that Alzheimer’s disease is not natural aging. It is a progressive disease that causes the abnormal death of brain cells. The initial signs of dementia often include memory loss, but as the disease progresses, it affects more of the brain until the person is unable to move, swallow or breathe.
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Dementia And The Brain
Knowing more about the brain and how it can change can help to understand the symptoms of dementia. It can help a person with dementia to live well, or to support a person with dementia to live well.
These pages explain which areas of the brain are responsible for certain skills and abilities, and how these are affected by dementia. We explain how changes to the brain relate to changes a person may notice as the condition progresses.
This information is helpful for anyone who wants to find out more about how the brain is affected by dementia.
Age Distribution For Alzheimer Disease
The prevalence of AD increases with age. AD is most prevalent in individuals older than 60 years. Some forms of familial early-onset AD can appear as early as the third decade, but familial cases constitute less than 10% of AD overall.
More than 90% of cases of AD are sporadic and occur in individuals older than 60 years. Of interest, however, results of some studies of nonagenarians and centenarians suggest that the risk may decrease in individuals older than 90 years. If so, age is not an unqualified risk factor for the disease, but further study of this matter is needed.
Savva et al found that in the elderly population, the association between dementia and the pathological features of AD is stronger in persons 75 years of age than in persons 95 years of age. These results were achieved by assessing 456 brains donated to the population-based Medical Research Council Cognitive Function and Ageing Study from persons 69-103 years of age at death.
Studies have demonstrated that the relationship between cerebral atrophy and dementia persist into the oldest ages but that the strength of association between pathological features of AD and clinical dementia diminishes. It is important to take age into account when assessing the likely effect of interventions against dementia.
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Alzheimer’s Stages And Progression
In the early stages of Alzheimers disease and dementia, neurons and their connections are destroyed in the areas of the brain which support memory. In later stages, brain functions involving language, reasoning, and regulating behavior become affected. In most cases, the patient will eventually lose their ability to safely live independently.
In the late stages of Alzheimers, as more neurons are lost, many areas of the brain shrink in size. This process is referred to as widespread brain atrophy, resulting in a significant loss of nerve tissue and severely impaired brain function2.
Support For Families And Alzheimer’s Disease Caregivers
Caring for a person with Alzheimers can have significant physical, emotional, and financial costs. The demands of day-to-day care, changes in family roles, and decisions about placement in a care facility can be difficult. NIA supports efforts to evaluate programs, strategies, approaches, and other research to improve the quality of care and life for those living with dementia and their caregivers.
Becoming well-informed about the disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimers and about ways to deal with difficult behaviors and other caregiving challenges can help.
Good coping skills, a strong support network, and respite care are other things that may help caregivers handle the stress of caring for a loved one with Alzheimers. For example, staying physically active provides physical and emotional benefits.
Some caregivers have found that joining a support group is a critical lifeline. These support groups enable caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. Many organizations sponsor in-person and online support groups, including groups for people with early-stage Alzheimers and their families.
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Is There Treatment Available
At present there is no cure for Alzheimers disease. However, one group of drugs called cholinergeric drugs appears to be providing some temporary improvement in cognitive functioning for some people with mild to moderate Alzheimers disease.
Drugs can also be prescribed for secondary symptoms such as restlessness or depression or to help the person with dementia sleep better.
Community support is available for the person with Alzheimers disease, their families and carers. This support can make a positive difference to managing dementia. Dementia Australia provides support, information and counselling for people affected by dementia. Dementia Australia also aims to provide up-to-date information about drug treatments.
For more information contact the National Dementia Helpline on 1800 100 500.
For a range of books and videos contact our Library.
For advice, common sense approaches and practical strategies on the issues most commonly raised about dementia, read our Help Sheets.
The Role Of Neurofibrillary Tangles
The second major finding in the Alzheimer’s brain is neurofibrillary tangles. These tangles are composed of Tau proteins, which play a crucial role in the normal structure and function of the neuron. In people with Alzheimer’s disease, the formally straight Tau proteins have mutated, due to overactive enzymes, resulting in twisted strands that aggregate together and become tangles. These tangles acculumulate inside the neuron, disrupt cell activity , and result in the death of the neuron.
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Lbs In Other Disorders
LBs are found in about 10% of brains from normal elderly individuals over age 65 years . These cases may represent the earliest stages of PD, and the distribution of LBs and the non-motor clinical manifestations in some cases seem to favor this argument . In particular, such cases have LBs, albeit in small numbers and not accompanied by neuronal loss or gliosis, in brain regions that are vulnerable to pathology in full-blown PD. Given the lack of overt parkinsonism, such cases have been referred to as being incidental. It is not known whether these individuals, who may or may not have non-motor prodromal features of PD, would have eventually progressed to PD, but preliminary evidence favors this hypothesis .
Pure Autonomic Failure
When the involvement of the autonomic nervous system in PD and prodromal PD was investigated, it was found that some individuals with pure autonomic failure have LB pathology at autopsy . In those cases, LBs were detected in brain and autonomic ganglia and LNs in sympathetic nerve fibers in epicardium and peri-adrenal tissues . It is of interest that PD and individuals with incidental LBS may also have adrenal -synuclein pathology .
Dementia with LBs
R.A. Armstrong DPhil, in, 2015
How Dementia Affects The Brain
Dementia is not kind to the brain. However, most people believe dementia destroys the entire brain at once. Actually, dementia only focuses on three of the six major regions of the brain. To understand the destruction of dementia you must understand each of the lobes which could be affected and then the functions carried out by that portion of the brain. Different types of dementia damage specific regions of the brain while leaving other regions untouched. For example, Alzhemiers is a type of dementia but it usually only ravages the memory which is located in the temporal lobe.
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Ps1 And Ps2 Mutations
Approximately 50-70% of early-onset autosomal-dominant AD cases appear to be associated with a locus mapped by genetic linkage to the long arm of chromosome 14 . Numerous missense mutations have been identified on a strong candidate gene, called PS1.
At the same time, another autosomal dominant locus responsible for early-onset AD was localized to chromosome 1. Two mutations were identified on the candidate gene, designated PS2. The physiological role of presenilins and the pathogenic effects of their mutations are not yet well understood.
How Do Doctors Diagnose Lewy Body Dementia
Unfortunately, LBD is usually the most frequently misdiagnosed type of dementia. LBDA estimates that it often takes about three doctors and over a year and a half to diagnose LBD. Their survey of nearly 1,000 participants with LBD discovered that about 80 percent of them were misdiagnosed. In an article published in nature, Susan Schneider Williams, Robin Williams wife, writes about their struggle to get an accurate diagnosis and determine what was happening to his brain. My hope is that it will help you understand your patients along with their spouses and caregivers a little more. And as for the research you do, perhaps this will add a few more faces behind the why you do what you do, she writes.
People can either be diagnosed with dementia with Lewy bodies or Parkinsons disease dementia. If someone is experiencing symptoms that could be LBD, they should try visiting a neurologist, rather than a general physician, to try and get an accurate diagnosis. While LBD can still only be officially diagnosed by an autopsy, doctors use the following methods to determine if someone may have LBD:
They can look for biomarkers of Lewy Body Dementia, including abnormal proteins, with the following:
- A SPECT or PET scan
- cardiac scintigraphy, which looks at how nerves are functioning in the hearts blood vessels
- Sleep tests that monitor brain waves
In addition, doctors may do the following:
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How Dementia Affects Various Lobes Of The Brain
- Where planning occurs
- Ability to comprehend a complex idea
- Ability to change a behavior
- Ability to focus attention
- Control urges- may desire to be close and show affection
- Where personality traits reside- may have subtle personality changes
- Safety awareness
- Ability to get along in a new situation
- Interpret sounds: language vs. non-language
- Ability to write/draw
- Internal maps of the world
- Ability to sequence
- Understand consequences of behavior
- Difficulty knowing the correct purpose of an object
- Knowledge of numbers and their relatio
- Depth perception- high-stepping over surfaces
- Peripheral vision- many persons with dementia cannot see to the sides. This is why we do not approach from the side.
- Process movement- go slow and hold palms out
- Fine visual discrimination- Use vivid colored plates, cups and table tops because those with dementia cannot see things that are too similar in color. Red, navy blue, black and turquoise are good colors.
- Retrieval of short-term memory and long-term memory
- Retrieve and store information
Pathway Breakdown Leading To Alzheimers Damage
In the second breakdown pathway APP is split by enzymes B-secretase then y-secretase . Some of the fragments that result stick together and form a short chain called an oligomer. Oligomers are also known as ADDL, amyloid-beta derived diffusible ligands. Oligomers of amyloid beta 42 have been shown to cause problems in the communication between neurons. Amyloid beta 42 also produces tiny fibers, or fibrils. When they stick together they form amyloid plaque. Some of these plaques can insert themselves into the membrane of the neuron cell causing substances outside the cell to leak into it, causing further damage. This damage results in a buildup of Amyloid beta 42 peptides leading to neuron dysfunction.
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Alzheimers Disease Research Efforts
Because the diagnosis of Alzheimers has been challenging, its been hard for clinical trials to make sure theyre including people with the disease. As advances in the field make it easier to diagnose Alzheimers, it will be easier for clinical trials to study new treatments.
- In 2020, as many as 5.8 million Americans were living with Alzheimers disease.1
- Younger people may get Alzheimers disease, but it is less common.
- The number of people living with the disease doubles every 5 years beyond age 65.
- This number is projected to nearly triple to 14 million people by 2060.1
- Symptoms of the disease can first appear after age 60, and the risk increases with age.
Chemical Changes To The Brain
Within the different regions of the brain, the work of forming thoughts and moving our bodies happens on a cellular level. Chemically, tiny electrical charges or signals move through individual cells and parts of the brain. When these processes are compromised, so too are basic brain tasks, such as thinking, feeling, and forming and recalling memories.
In an individual with dementia, neurons carrying signals to and from the brain are destroyed. Signals transmitted between brain cells carried by neurotransmitters are interrupted, and connections between nerve cells of the brain become broken. This is why someone with dementia has problems with thoughts and movement: The communication between cells in their bodies has broken down.
Beta-Amyloid Plaques and Tau TanglesTwo toxic proteins appear to be responsible for the cellular brain damage: beta-amyloid and tau.
When Alzheimers disease begins to develop, part of the neuron that normally helps promote cell growth and survival breaks down in an abnormal way and begins producing a toxic protein called beta-amyloid. Beta-amyloid plaques, which form between neurons, damage neurons in at least two ways: They affect the neurons receptor for a particular neurotransmitter, and that, in turn, interferes with the cells ability to function and send messages to other neurons.
Alzheimers Affects The Brain Due To Impaired Nutrition
In Alzheimers, a protein called tau is deposited in microtubules in normal brain tissues. These microtubules are important for normal functioning of the brain and for transporting nutrients to the cells. As Alzheimers disease affects these areas, the brain cells that fail to receive nutrients eventually die out.
Two Of The Following Are Present :
- Fluctuating cognition: Mental problems varying during the day, especially attention and alertness.
- Visual hallucinations: Detailed and well-formed visions, which occur and recur.
- RBD: Physically acting out dreams while asleep.
A DLB diagnosis is even more likely if the individual also experiences any of the following: repeated falls, fainting, brief loss of consciousness, delusions, apathy, anxiety, problems with temperature and blood pressure regulation, urinary incontinence, and chronic constipation, loss of smell, or sensitivity to neuroleptic medications that are given to control hallucinations and other psychiatric symptoms.
Finally, the timing of symptoms is a reliable clue: if cognitive symptoms appear before or within a year of motor symptoms, DLB is more likely the cause than Parkinsonâs disease. Signs of stroke or vascular dementia usually negate the likelihood of DLB.
Testing is usually done to rule out other possible causes of dementia, motor, or behavioral symptoms. Brain imaging can detect brain shrinkage and help rule out stroke, fluid on the brain , or subdural hematoma. Blood and other tests might show vitamin B12 deficiency, thyroid problems, syphilis, HIV, or vascular disease. Depression is also a common cause of dementia-like symptoms. Additional tests can include an electroencephalogram or spinal tap .
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