New Cerebrum Story: Lewy Body Dementia

Google the terms “Lewy body dementia”
and “Alzheimer’s disease” appears in most search results. The two are linked
through common symptoms, but their differences can have drastic implications. In
this month’s Cerebrum story: “Lewy Body Dementia:
The Under-Recognized But Common Foe
,” by James E. Galvin, M.D., M.P.H., and Meera Balasubramaniam, M.D., the
authors stress that diagnosing Lewy body
(LBD) incorrectly, or as Alzheimer’s disease, “may expose patients to
potentially dangerous adverse reactions to certain medications (such as classic
neuroleptic medications like haloperidol).” The writers add:  “Early and accurate diagnosis helps families
Shutterstock_152054402(1) copy for their role in caregiving, specifically the behavioral management
and their own emotional preparation in anticipation of the disease course, one
that may have its own unique challenges and burdens.”

After Alzheimer’s disease, LBD is the most
prevalent progressive dementia of the more than 100 forms. LBD, which affects
1.3 million people in the US, is characterized
by the presence of Lewy bodies, which are abnor

mal aggregates of a protein
called alpha-synuclein. Found in regions of the brain that regulate behavior,
memory, movement, and personality, Lewy bodies were first described in the early 1900s by
Friederich H. Lewy while researching Parkinson’s disease. The first case of LBD,
however, was not described until 1961, with the first set of clinical criteria introduced
in 1996.

Because many of the symptoms of Alzheimer’s, Parkinson’s, and LBD
overlap, LBD is difficult to diagnose. Underdiagnosis is just part of the
reason why LBD is not well known to the public or many health-care providers,
and why funding for research to find the causes and develop therapies for LBD
lags far behind that for almost every other cognitive disorder.

The authors, who collaborate at the New York
University Langone School of Medicine, point out ways to recognize the
differences between LBD and Alzheimer’s. “In its early stages, LBD is more likely to be
associated with psychiatric symptoms. The patient not only sees nonexistent
people, animals, body parts, or even vehicles, but may describe them in detail.
He or she may even respond by talking to the hallucinations. Paranoia toward
caregivers and unshakable false beliefs, such as that family members are being
replaced by impostors, are more prevalent among individuals with LBD than among
Alzheimer’s patients.” But they also warn that “patients with Alzheimer’s
frequently develop psychotic symptoms later in the course of the disease, such
that the late stages of LBD and Alzheimer’s may be indistinguishable.”

The authors advocate drug
development, but acknowledge that the problems diagnosing
LBD means finding appropriate patients for therapy is a factor in holding
clinical trials. The good news is that drugs that become FDA-approved
for dementia in Parkinson’s and in Alzheimer’s may be ideal candidates for future
clinical trials in LBD.

The ramifications for
underfunding are serious. The most rigorous study to date about the financial
costs to care for people with dementia, published last April in the New
England Journal of Medicine
, found that the financial burden is at least that of heart
disease or cancer, and probably higher. The New York Times
concluded that “the bottom line is that both the costs and the number of people
with dementia will more than double within 30 years, skyrocketing at a rate
that rarely occurs with a chronic disease.”

Families who have a loved one
with LBD dementia would most likely point out that the emotional burden can’t
be measured in dollars.

–Bill Glovin

One response

  1. Wow, the number of people with dementia will more than double within the next 30 years is a scary statistic.
    That makes it all the more important to keep up with a regular exercise regimen from youth through old age to help combat the effects of aging on the brain.

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