“My mom has dementia,” the woman
said. “How is that different from Alzheimer’s?”
“I think of dementia as an
umbrella,” I said. “Beneath the umbrella of dementia are several diseases.
Alzheimer’s is the most common kind of dementia.”
In the 2017 Alzheimer’s Disease Facts and Figures, the Alzheimer’s
Association lists several diseases that cause dementia and associated
characteristics. They are Alzheimer’s, vascular dementia, dementia with Lewy
bodies, mixed dementia (more than one cause—the most common is Alzheimer’s and
vascular dementia), frontotemporal dementia, Parkinson’s disease,
Creutzfeldt-Jakob disease (rare, can be genetic or caused by consuming products
from cattle with mad cow disease), and normal pressure hydrocephalus.
The Alzheimer’s Association does
not list the rare disease Jim had. His diagnosis was early onset Alzheimer’s
disease, but his autopsy revealed the disease he actually had was corticobasal
ganglionic degeneration, a disease I had never heard of. The report also
mentions “incidental Lewy body,” severe frontotemporal atrophy, tau positive
glial inclusions in the white matter, but no evidence of Alzheimer’s disease.
It is easy to understand with
overlapping symptoms why diagnosis is so difficult. While searching for an
answer to the “why” of Jim’s dementia, we received several conflicting
theories, including Parkinson’s and Pick’s disease, before physicians finally settled on
Alzheimer’s.
Of course, the mention of Lewy body
in Jim’s autopsy, incidental aside, had me researching Lewy Body Dementia (LBD).
This disease affects around a million people in the United States.
There is no single test to diagnose
LBD, and in the early stages, it may be confused with Alzheimer’s, Parkinson’s,
or a mental disorder. Diagnosis is made through examination, laboratory tests,
brain imaging, and testing memory and cognition.
Through my volunteer work with the
Alzheimer’s Association, I’ve met fellow advocates diagnosed with LBD. I
remember one man telling me that his hallucinations were disruptive and
disturbing. Unfortunately, people with hallucinations or other behavior
problems may be treated with anti-psychotic drugs. Haloperidol (Haldol®),
olanzapine (Zyprexa®), and resperidone (Risperdal®) should be avoided because
of dangerous side effects, including an increased risk of death.
Lewy bodies attack several
different regions of the brain, which causes a variety of problems for the
person with the disease. Short-term memory, perception difficulties, processing
information, and language issues can be confused with Alzheimer’s. Movement
disorders are similar to Parkinson’s with tremor and muscle stiffness. The
distinction between LBD and Parkinson’s dementia is based on the timing of
dementia. In LBD, dementia will quickly follow parkinsonism within a year, but
people can have Parkinson’s and not develop dementia for many years.
People with LBD often have sleep
disorders. The vivid dreams associated with REM disorder may cause a variety of
symptoms ranging from talking while sleeping to punching a bed partner. A
person with LBD may be tired all the time due to insomnia or restless leg syndrome.
They may sleep excessively during the daytime.
LBD is managed in much the same way
as Alzheimer’s disease. In addition to physical, speech, and occupational
therapy, the Alzheimer’s drug Exelon® may be used. Other drugs may be used to
help with movement, sleep disorders, and behavioral problems. The surgical
procedure used to relieve the movement symptoms of Parkinson’s is not used when
a person has LBD because it may adversely affect cognition.
LBD causes a variety of behavior
and mood changes running the gamut from depression and apathy to agitation,
delusions, and paranoia. Managing the health care of a loved one with LBD can
be quite challenging for a care partner. If you are caring for a person with
LBD, it is important to enlist help from family and friends.
Taking care of yourself and taking
breaks will make you a better caregiver. Do not neglect your own health! When
dealing with a progressive, degenerative disease, it is crucial that you find
moments of joy. Continue to enjoy activities with your loved one as much as you
can for as long as you can. Convert challenges into opportunities to use your
creativity to live life to the fullest.
Copyright © March 2017 by L.S.
Fisher
For an informative publication
about Lewy Body Dementia: https://www.nia.nih.gov/alzheimers/publication/lewy-body-dementia/introduction
No comments:
Post a Comment