Lewy Body Dementia.

• Symptoms of Lewy Body Dementia - Lewy Body Dementia has 4 key features-cognitive or memory fluctuations, visual hallucinations, rapid eye movement (REM) sleep behavior disorder (RBD), and parkinsonism- slow movements, tendency to shuffle.

• Unlike Alzheimer disease which typically starts with short term memory loss, Lewy Body Dementia starts with early impairments in attention, executive and visuospatial function, with memory affected later in the course of the disease.

• There can be a fluctuating mental state and alertness.  They may be agitated, very confused and hallucinating for some of the time and more settled at other times.

• The fluctuations can occur over a period of hours.  They can develop extreme confusion, difficulty walking and settling at night. 

• Visual hallucinations occur early in up to 70 percent of patients with Lewy Body Dementia.

• However, these features can also be seen in Alzheimer’s dementia.

• REM sleep behaviour disorder characterized by dream re-enactment behavior and recurrent sleep-related vocalisation and complex movements.

• Falls are very common in Lewy Body Dementia from parkinsonism, slowed reflexes and shuffling, cognitive fluctuations, and from postural hypotension.

• The diagnosis is a clinical diagnosis- there is no one special test.

• These patients with Lewy Body Dementia may benefit from Cholinesterase inhibitor drugs, just like in Alzheimer’s dementia.

• It is important in these type of patients that potent Dopamine-blocking anti-psychotics drugs such as Haloperidol or Risperidone are avoided when treating psychoses such as delusions, hallucinations and agitation, as they can make their Parkinson’s-like symptoms of stiffness, tremor, shuffling and balance worse.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.