This common dementia is caused by a buildup of proteins in the brain, and it affects thinking, memory and motor control.
Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimer's disease. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).
Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention. Other effects include Parkinson's disease signs and symptoms such as rigid muscles, slow movement, walking difficulty and tremors.
Lewy body dementia signs and symptoms can include:
Lewy body dementia is characterized by the abnormal buildup of proteins into masses known as Lewy bodies. This protein is also associated with Parkinson's disease. People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer's disease.
A few factors seem to increase the risk of developing Lewy body dementia, including:
Lewy body dementia is progressive. Signs and symptoms worsen, causing:
A diagnosis of Lewy body dementia requires a progressive decline in your ability to think, as well as at least two of the following:
Autonomic dysfunction, which involves instability in blood pressure and heart rate, poor regulation of body temperature, sweating, and related signs and symptoms, supports a Lewy body dementia diagnosis. So does sensitivity to antipsychotic drugs, particularly first-generation antipsychotics such as haloperidol (Haldol). Medications like Haldol aren't used for people with Lewy body dementia because they can cause a severe reaction.
No single test can diagnose Lewy body dementia. The diagnosis is based the on signs and symptoms you have and ruling out other conditions that can cause similar signs and symptoms. Tests might include:
Your doctor may check for signs of Parkinson's disease, strokes, tumors or other medical conditions that can affect the brain and physical function. A neurological examination tests:
A short form of this test, which assesses your memory and thinking skills, can be done in less than 10 minutes in your doctor's office. It's not generally useful in distinguishing Lewy body dementia from Alzheimer's disease but can determine whether cognitive impairment is present. Longer tests that take several hours help identify Lewy body dementia.
These can rule out physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.
Your doctor might order an MRI or CT scan to identify a stroke or bleeding and to rule out a tumor. While dementias are diagnosed based on the medical history and physical examination, certain features on imaging studies can suggest different types of dementia, such as Alzheimer's or Lewy body dementia.
If the diagnosis is unclear or the signs and symptoms aren't typical, your doctor might suggest additional imaging tests, including these that can support a diagnosis of Lewy body dementia:
Your doctor might order a sleep evaluation called a polysomnogram to check for REM sleep behavior disorder or an autonomic function test to look for signs of heart rate and blood pressure instability.
In some countries, doctors might also order a heart test called myocardial scintigraphy to check the blood flow to your heart for indications of Lewy body dementia. However, the test isn't used in the United States.
Research is ongoing into other indicators of Lewy body dementia. These biomarkers might eventually enable early diagnosis of Lewy body dementia before the full disease develops.
There's no cure for Lewy body dementia but many of the symptoms can improve with targeted treatments.
Cholinesterase inhibitors. These Alzheimer's disease medications, such as rivastigmine (Exelon), donepezil (Aricept) and galantamine (Razadyne), work by increasing the levels of chemical messengers in the brain (neurotransmitters) believed to be important for memory, thought and judgment. This can help improve alertness and cognition and might reduce hallucinations and other behavioral problems.
Possible side effects include gastrointestinal upset, muscle cramps and frequent urination. It can also increase the risk of certain cardiac arrhythmias.
In some people with moderate or severe dementia, an N-methyl-d-aspartate (NMDA) receptor antagonist called memantine (Namenda) might be added to the cholinesterase inhibitor.
Certain medications can worsen memory. Try to avoid over-the-counter sleep aids that contain diphenhydramine (Advil PM, Aleve PM) and medications used to treat urinary urgency such as oxybutynin (Ditropan XL).
Also limit sedatives and sleeping tablets, and talk to your doctor about whether any of the drugs you take might make your memory worse.
Antipsychotic drugs can cause severe confusion, severe parkinsonism, sedation and sometimes death. Very rarely, certain second-generation antipsychotics, such as quetiapine (Seroquel) or clozapine (Clozaril, Versacloz) might be prescribed for a short time at a low dose but only if the benefits outweigh the risks.
Because antipsychotic drugs can worsen Lewy body dementia symptoms, it might be helpful to first try nondrug approaches, such as:
Symptoms and progression are different for everyone with Lewy body dementia. Caregivers and care partners may need to adapt the following tips to individual situations:
Limiting caffeine during the day, discouraging daytime napping and offering opportunities for daytime exercise might help prevent nighttime restlessness.
Frustration and anxiety can worsen dementia symptoms. To promote relaxation, consider:
People with Lewy body dementia often have a mixture of emotions, such as confusion, frustration, anger, fear, uncertainty, grief and depression. Offer support by listening, reassuring the person that he or she still can enjoy life, being positive, and doing your best to help the person retain dignity and self-respect.
If you're a caregiver or care partner for someone with Lewy body dementia, watch the person closely to make sure he or she doesn't fall, lose consciousness or react negatively to medications. Provide reassurance during times of confusion, delusions or hallucinations.
Caring for a person with Lewy body dementia can be exhausting physically and emotionally. You may have anger, guilt, frustration, discouragement, worry, grief or social isolation. Help prevent caregiver burnout by:
Many people with Lewy body dementia and their families can benefit from counseling or local support groups. Contact your local agencies on health or aging to get connected with support groups, doctors, resources, referrals, home care agencies, supervised living facilities, a telephone help line and educational seminars.
You'll probably first discuss your symptoms with your family doctor, who may refer you to a doctor trained in dementia — usually a doctor trained in brain and nervous system conditions (neurologist) or mental health conditions (psychiatrist).
Ask a friend or family member to the appointment, if possible, to help you remember the information you're given and give your doctor information about you. Here's some information to help you get ready for your appointment.
Make a list of:
Your doctor is likely to ask you and your spouse, partner or close friend a number of questions about:
June 8th, 2021