IntroductionAlzheimer’sand Dementia with Lewy bodies (DLB) are two separate but similar conditions. Alzheimer’s damagesthe hippocampus, which alters the brain’s ability to store memories whichcauses memory loss, the symptom the disease is most commonly known for. Dementia with Lewy bodies, on the other hand,affects different functions of the brain, specifically the ability to reason andsolve problems.
Although there are tests that can be taken out to more conclusively determine ifa patient has these conditions, in general, both Alzheimer’s and DLB arediagnosed through observation and tracking the progression of a patients behaviourand symptoms. Dementia with Lewy bodies (DLB)Dementia with Lewy bodies (DLB) is a progressive typeof dementia that can go from confusion and different behaviour/waysof thinking to a complete declinein thinking, responding normal behaviour, reasoningand eventuallynormal, independent function in everyday situations. DLB is detected by the abnormal masses of proteinsbuilding up into deposits known as Lewybodies. This protein, however, is also associated with Parkinson’s disease and Parkinson’sdementia disease, which can cause difficulties when diagnosing a patient.People who have Lewy bodies intheir brains often also have the plaques and tangles associated withAlzheimer’s disease.
Plaques and tangles can causemajor tissue loss and the death of cells in the brain of an Alzheimer’s patient. Plaques are unusual clumps of “sticky” proteins calledbeta-amyloid that build up around and in-between nerve cells.Symptoms of DLB DLB patients oftenhave a common symptom of becoming randomly confused about theirlocation or actions and they may not understand whatthey are doing and/or their surroundings during the day. Theycan possibly become panicked or frightened easily and be more alert thanusual. Another main symptom of DLB is a change in the way someone thinks, talksor acts.
Like most DLB symptoms, this change is not always easy to pick upon at first however it becomes more noticeable as thecondition becomes more severe. This pattern is also seen inhallucinations patients are known to experience, they often start out a smallfigments of the imagination, such as animals, and progressively worsen intocomplete delusions with the patients believing that certain aspects of theirlives are completely different to reality. The disease also has mutual symptomswith Parkinson’s and Alzheimer’s disease. Someone suffering from DLB may experiencea different or unusual posture, stiff or sore muscles and problems stayingstable and balancing, much like many Parkinson’s patients. Alzheimer’s most well-knownsymptom is memory loss and this symptom is also present in DLB patients. Thoughnot often as severe as that of Alzheimer’s patients, sufferers can experiencememory loss as both diseases damage the hippocampus, the part of the brain thatstores information as memories.
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This can also lead to patients being unable to understandviual information.DiagnosisSimilar to othertypes of dementia thereis not one completely accurate, individual test that can determine the presenceof DLB nor a definitive cure. Currently, DLB is a clinical diagnosis, meaning itis based on the doctor’s judgement and what condition they believe the patientto have the traits/symptoms of. The only way to conclusively and definitivelydiagnose DLB is after a patient has died through an examination of the body.Which is only partially useful as obviously doctors need to be able to diagnosethe disease while the patient is alive so they can begin treatmentMany scientists anddoctors believe that DLB and Parkinson’s disease dementia (PDD) branch off fromthe same problems but develop separately, due to their similarities.
However, itis important that they are diagnosed separately for now so patients can followthe most efficient path of treatment until more advanced cures and diagnosismethods are developed. Doctors will diagnose patients with DLB when thesymptoms are clearly present and have developed about a year or less after themovement function symptoms shared with Parkinson’s, as those symptoms areusually present before the rest.Scientists haven’t found anyclear causes of DLB.Nearly all patients diagnosed lack genetic links to thedisease and have an average lifestyle and average health. The patients thathave been recorded have different genders, lifestyles, ethnicities and standardsof living that share little to no correlation, however the disease is morecommon in those that are middle-aged and above. PrognosisDLB has no cure and thereare no existing treatments that can slow down or prevent the brain cell damagecaused by DLB; it is a progressive, life shortening disease that causes irreparabledamage that cannot yet be stopped.
Currently,strategies focus on developing and using medicines to help alleviate/managesymptoms. Alzheimer’s diseaseAlzheimer’sdisease is the most common cause of dementia. The word dementia describes a groupof symptoms that can include memory loss and difficulties with thinking,problem-solving or language, however many people just associate it with thememory loss. These symptoms occur when the brain is damaged by certaindiseases, including Alzheimer’s disease.
proteins build up in the brain to formstructures called ‘plaques’ and ‘tangles’. This leads to the loss ofconnections between nerve cells, and eventually to the death of nerve cells andloss of brain tissue. People with Alzheimer’s also have a shortage of someimportant chemicals in their brain. These chemical messengers help to transmitsignals around the brain. When there is a shortage of them, the signals are nottransmitted as effectively, leading to the brain to not function how it should.
As discussed below, current treatments for Alzheimer’s disease can help createmore of these important chemical messengers in the brain, which can help thebrain to function how it should and help and even possibly stop some of thesymptoms.SymptomsThe symptoms of Alzheimer’sdisease progress slowly over several years. Sometimes these symptoms areconfused with other conditions and may initially be put down to old age.The rate at which the symptomsprogress is different for each individual and it’s not possible to predictexactly how quickly it will get worse.In some cases, infections,medications, strokes or delirium can be responsible for symptoms gettingworseGenerally,the symptoms of Alzheimer’s disease are divided into three main stages.Early symptomsInthe early stages, the main symptom of Alzheimer’s disease is memorylapses. For example, someone with early Alzheimer’s disease may sometimesforget the names of places and objects, or have trouble thinking of the rightword, which many people with healthy brains sometimes do however it becomesconsiderably more noticeable when their memory begins to completely deteriorate.
They will start to often repeat themselves as well as begin to find it hard tomake decisions and avoid trying new things.Thereare often signs of mood changes, such as increasing anxiety or agitation,or periods of confusion, much like DLB.Middle-stage symptomsAsAlzheimer’s disease develops, memory problems will get worse.
Someone with thecondition may find it increasingly difficult to remember the names ofpeople they know and may struggle to recognise their family and friends.Othersymptoms may also develop, such as: increasing confusion and disorientation – for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speech or language (aphasia) disturbed sleep changes in mood, such as frequent mood swings, depression and feeling increasingly anxious, frustrated or agitated difficulty performing spatial tasks, such as judging distances hallucinationsBythis stage, someone with Alzheimer’s disease usually needs support to help themwith their everyday living. For example, they may need help eating,washing, getting dressed and using the toilet.LateSymptomsInthe later stages of Alzheimer’s disease, the symptoms become increasinglysevere and distressing for the person with the condition, as well as theircarers, friends and family.
Hallucinationsand delusions may come and go over the course of the illness, but canget worse as the condition progresses. Sometimes people with Alzheimer’sdisease can be violent, demanding and suspicious of those around them.Anumber of other symptoms may also develop as Alzheimer’s disease progresses,such as:o difficultyeating and swallowing (dysphagia)o difficulty changing position or moving aroundwithout assistanceo considerable weight loss – although somepeople eat too much and put on weighto unintentionalpassing of urine (urinary incontinence) orstools (bowelincontinence)o gradual loss of speecho significant problems with short- and long-termmemoryo In the severe stages of Alzheimer’s disease, peoplemay need full-time care and assistance with eating, moving and using thetoilet. CausesThe exact cause is unknown but wedo know that ‘plaques’ and ‘tangles’ form in the brain due to two proteinscalled amyloid (plaques) and tau (tangles). Amyloid is a naturally occurring protein which for a reason that is not yet understood begins to malfunction, creating beta amyloid which is toxic to the brain cells. Plaques form consisting of dead cells and amyloid protein.
Tau protein naturally occurs in the brain and helps brain cells communicate with each other but for a reason that is not yet understood it can become abnormal and “clump together” leading to death of the brain cells affected. Anumber of factors are thought to increase your risk of developing thecondition. These include:o increasing ageo a family history of the conditiono previous severehead injurieso lifestyle factors and conditions associatedwith cardiovasculardisease DiagnosisThere is no single test for Alzheimer’s disease. AGP will first need to rule out conditions that can have similar symptoms, suchas infections, vitamin and thyroid deficiencies (from a blood test), depressionand side effects of medication.The doctor will also talk to the person, and wherepossible someone who knows them well, about their medical history and how theirsymptoms are affecting their life.
The GP or a practice nurse may ask theperson to do some tests of mental abilities.The GP may feel able to make a diagnosis ofAlzheimer’s at this stage. If not, they will generally refer the person to aspecialist. This could be an old-age psychiatrist (who specialises in themental health of older people) often based in a memory service. Or it might bea geriatrician (who specialises in the physical health of older people), aneurologist (who specialises in conditions of the brain and nervous system) ora general adult psychiatrist (who specialises in mental health in adults) in ahospital.The specialist will assess the person’s symptoms,and how they developed, in more detail. In Alzheimer’s disease there willusually have been a gradual worsening of memory over several months.
A familymember may be more aware of these changes than the person with suspectedAlzheimer’s is themselves.The person’s memory, thinking and other mentalabilities will also be assessed further with a pen-and-paper test. When someonewith Alzheimer’s is tested, they will often forget things quite quickly. Theywill often not be able to recall them a few minutes later even when prompted.The person may undergo a brain scan, which can showwhether certain changes have taken place in the brain. There are a number ofdifferent types of brain scan.
The most widely used are CT (computerisedtomography) and MRI (magnetic resonance imaging). A brain scan may rule outcertain conditions such as stroke, tumour or a build-up of fluid inside thebrain. These can have symptoms similar to those of Alzheimer’s.
It may alsoclarify the type of dementia. In a person with early Alzheimer’s disease abrain scan may show that the hippocampus and surrounding brain tissue haveshrunk.PrognosisCurrently, there is no cure for Alzheimer’s,however, drug and non-drug treatments may help with both cognitive andbehavioral symptoms.
