What is Dementia with Lewy bodies?
Dementia with Lewy Bodies (“DLB”) is a type of progressive dementia, meaning decline will increase with time, and includes decreased abilities in thinking, reasoning and independent function due to the presence of Lewy bodies, abnormal microscopic deposits that damage brain cells over time. DLB is likely the second most common cause of dementia after Alzheimer’s disease and can be read about in-depth in the book, Dementia with Lewy Bodies, by Kenji Kosaka. The author discusses not only the diagnostic criteria of DLB but also a variety of imaging modalities and biological markers that may be helpful in diagnosing this dementia with often unknown causes.
Why is it important to understand the hallmarks of a particular type of dementia in probate litigation?
When challenging a will, or responding to a will contest, the hallmarks of DLB are recognizable by trained physicians / psychiatrists. We believe some of the important keys for discovery during will contest (or trust contest) litigation based on lack of capacity due to DLB include relatively quick onset of executive dysfunction, Parkinsonism (“a general term that refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinson’s disease, such as tremors, slow movement and stiffness”, *per the National Parkinson Foundation), attention impairment, and dramatically varying degrees of cognitive problems. If counsel does not conduct discovery with an understanding to the specific type of dementia, key facts and elements of proof may be missed.
What exactly are Lewy bodies?
The hallmark of DLB are abnormal deposits of a protein called alpha-synuclein in the brain. These deposits are called Lewy bodies, so named after Frederich H. Lewy, M.D., a neurologist who discovered them while working with Dr. Alois Alzheimer’s in the early 1900s. The deposits affect chemicals in the brain, leading to problems with thinking, movement, behavior and mood.
What are some of the early symptoms of Lewy bodies?
Because of the progressive nature of Lewy bodies, the decline in general mental ability can be gradual and hard to track. Those with DLB often experience visual hallucinations and changes in alertness and attention. Parkinson’s disease-like symptoms also present themselves, such as rigid muscles, slow movements and tremors. Below is an explanation of the most common symptoms:
* Visual hallucinations: Hallucinations may be one of the first symptoms, and are often recurring. They may include seeing shapes, animals or people that aren’t there. Auditory, olfactory and tactile hallucinations are all possible.
* Movement disorders: Signs of Parkinson’s disease, such as slowed movement, rigid muscles, hunches posture, tremor or a shuffling walk may occur.
* Poor regulation of body functions: Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy bodies dementia. This can result in dizziness, falls and bowel issues such as constipation.
* Cognitive problems: Thinking problems similar to those of Alzheimer’s disease present themselves, such as confusion, poor attention, visual-spatial problems and memory loss.
* Sleep difficulties: Rapid eye movement (REM) sleep behavior disorder is common, which causes the patient to physically act out dreams while asleep, sometimes violently.
* Fluctuating attention: Episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.
* Memory loss: It may be significant, but less prominent than in Alzheimer’s.
I keep hearing mention of Parkinson’s disease in relation to Lewy bodies disease. Are they similar?
While Parkinson’s disease and Lewy bodies dementia share some similarities, they are two different conditions. The main difference is that Parkinson’s is a chronic, neurodegenerative movement disorder while dementia with Lewy bodies is a chronic, neurodegenerative cognitive (or “thinking”) disorder. Parkinson’s disease patients experience muscle rigidity, changes in speech and walking, and tremors. While they can develop Lewy bodies dementia over time, most patients do not. DLB patients have all of the cognitive symptoms discussed above in addition to some of the movement issues that are considered Parkinsonism symptoms.
Are there any specific risk factors associated with DLB?
Researchers have not yet identified a specific cause of dementia with Lewy bodies. Specifically, no genes linked to DLB have been conclusively identified. However, most patients are older than 60 and male. Most patients diagnosed with DLB have no family history of the disease.
Are there any complications with the disease?
Because dementia with Lewy bodies is progressive, symptoms will worsen over time. Common complications include severe dementia, aggressive behavior, increased risk of
falling and injury, worsening Parkinsonian symptoms and depression. On average, death occurs about eight years after symptoms are present.
Is there a cure or treatment for DLB?
There is currently a great effort afoot among researchers and scientists to find a cure and more effective treatment for all types of dementia. At this time, there are no known or generally accepted treatments that can slow or stop the brain cell damage caused by dementia with Lewy bodies. However, there are drug therapies available to treat the symptoms.
The Lewy Body Dementia Association (LBDA) is a nonprofit organization providing information and assistance to individuals with the disease, caregivers and medical professionals. You can reach the LBDA at lbda.org or 800-539-9767.
Source: Alzheimer’s Association