User:Mr. Ibrahem/Dementia with Lewy bodies

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Not to be confused with Lewy body dementia, an umbrella term that includes Parkinson's disease dementia as well as dementia with Lewy bodies.
Dementia with Lewy bodies
Other namesDiffuse Lewy body disease
See caption.
Microscopic image of a Lewy body (arrowhead) in a neuron of the substantia nigra; scale bar=20 microns (0.02mm)
SpecialtyNeurology, psychiatry
SymptomsDementia, abnormal behavior during REM sleep, fluctuations in alertness, visual hallucinations, slowness of movement[1]
Usual onsetAfter the age of 50,[2] median 76[3]
DurationLong term[4]
CausesUnknown[4]
Diagnostic methodBased on symptoms and biomarkers[1]
Differential diagnosisAlzheimer's, Parkinson's disease dementia, certain mental illnesses, vascular dementia[5]
MedicationAcetylcholinesterase inhibitors such as donepezil and rivastigmine;[6] melatonin[7]
PrognosisAverage survival 8 years from diagnosis[4]
FrequencyAbout 0.4% of persons older than 65[8]

Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in sleep, behavior, thinking, movement, and automatic bodily functions.[9] Memory loss is not always an early symptom.[10] The disease worsens over time and is usually diagnosed when cognitive decline interferes with normal daily functioning.[11][2] Heart function and every level of gastrointestinal function—from chewing to defecation—can be affected, constipation being one of the most common symptoms.[9][12] Low blood pressure upon standing can also occur.[9] It can affect behavior; mood changes such as depression and lack of interest are common.[11]

The exact cause is unknown,[4] but involves widespread deposits of abnormal clumps of protein in neurons of the diseased brain.[13] Most people do not have affected family, although occasionally it runs in a family.[4] Known as Lewy bodies (discovered in 1912 by Frederic Lewy)[14] and Lewy neurites, these clumps affect both the central nervous system and the autonomic nervous system.[15] REM sleep behavior disorder (RBD)—in which people lose the muscle paralysis that normally occurs during REM sleep and act out their dreams—is a core feature.[11] RBD may appear years or decades before other symptoms.[11] Other core features are visual hallucinations, marked fluctuations in attention or alertness, and parkinsonism (slowness of movement, trouble walking, or rigidity).[11] A presumptive diagnosis can be made if several disease features or biomarkers are present; the diagnostic workup may include blood tests, neuropsychological tests, imaging, and sleep studies.[11] A definitive diagnosis usually requires an autopsy.[11][2] Together with Parkinson's disease dementia, DLB is one of the two Lewy body dementias.[9]

There is no cure or medication to stop the disease from progressing,[16] and people in the latter stages of DLB may be unable to care for themselves.[17] Treatments aim to relieve some of the symptoms and reduce the burden on caregivers.[9][18] Medicines such as donepezil and rivastigmine are effective at improving cognition and overall functioning, and melatonin can be used for sleep-related symptoms.[19] Antipsychotics are usually avoided, even for hallucinations, because severe and life-threatening reactions occur in almost half of people with DLB,[20] and their use can result in death.[21] Management of the many different symptoms is challenging, as it involves multiple specialties and education of caregivers.[22][9][11]

DLB is a common form of dementia,[2] but the number of people affected is not known accurately[23][24] and many diagnoses are missed.[25] It typically begins after the age of fifty[2] and people with the disease live about eight years after diagnosis.[4] The disease was first described by Kenji Kosaka in 1976.[26]

References[edit]

  1. ^ a b McKeith IG et al. (2017), Table 1, p. 90 Archived August 28, 2021, at the Wayback Machine
  2. ^ a b c d e "Lewy body dementia: Hope through research". National Institute of Neurological Disorders and Stroke. US National Institutes of Health. January 10, 2020. Archived from the original on April 30, 2021. Retrieved March 18, 2020.
  3. ^ Hershey LA, Coleman-Jackson R (2019), p. 309.
  4. ^ a b c d e f "Dementia with Lewy bodies information page". National Institute of Neurological Disorders and Stroke. March 27, 2019. Archived from the original on June 10, 2021. Retrieved March 18, 2020.
  5. ^ Gomperts SN (2016), p. 437.
  6. ^ Taylor JP et al. (2020), sec. "Cognitive impairment".
  7. ^ Taylor JP et al. (2020), sec. "Sleep disturbances" ("Nocturnal sleep disturbances" and "Excessive Daytime Sleepiness" combined on final publication).
  8. ^ Levin J et al. (2016), p. 62.
  9. ^ a b c d e f Taylor JP, McKeith IG, Burn DJ, et al. (February 2020). "New evidence on the management of Lewy body dementia". Lancet Neurol (Review). 19 (2): 157–69. doi:10.1016/S1474-4422(19)30153-X. PMC 7017451. PMID 31519472. Courtesty link available here. Archived July 3, 2020, at the Wayback Machine
  10. ^ Tousi B (October 2017). "Diagnosis and management of cognitive and behavioral changes in dementia with Lewy bodies". Curr Treat Options Neurol (Review). 19 (11): 42. doi:10.1007/s11940-017-0478-x. PMID 28990131.
  11. ^ a b c d e f g h McKeith IG, Boeve BF, Dickson DW, et al. (July 2017). "Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium". Neurology (Review). 89 (1): 88–100. doi:10.1212/WNL.0000000000004058. PMC 5496518. PMID 28592453.
  12. ^ Palma JA, Kaufmann H (March 2018). "Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies". Mov Disord (Review). 33 (3): 372–90. doi:10.1002/mds.27344. PMC 5844369. PMID 29508455.
  13. ^ Walker Z, Possin KL, Boeve BF, Aarsland D (October 2015). "Lewy body dementias". Lancet (Review). 386 (10004): 1683–97. doi:10.1016/S0140-6736(15)00462-6. PMC 5792067. PMID 26595642.
  14. ^ Tahami Monfared AA et al. (2019), p. 290.
  15. ^ Lin YW, Truong D (April 2019). "Diffuse Lewy body disease". J. Neurol. Sci. (Review). 399: 144–50. doi:10.1016/j.jns.2019.02.021. PMID 30807982.
  16. ^ Yamada M, Komatsu J, Nakamura K, et al. (January 2020). "Diagnostic Criteria for Dementia with Lewy Bodies: Updates and Future Directions". J Mov Disord. 13 (1): 1–10. doi:10.14802/jmd.19052. PMC 6987529. PMID 31694357. DLB diagnoses are often missed.
  17. ^ "What is Lewy body dementia?". National Institute on Aging. US National Institutes of Health. June 27, 2018. Archived from the original on October 6, 2016. Retrieved March 18, 2020.
  18. ^ St Louis EK, Boeve BF (November 2017). "REM sleep behavior disorder: Diagnosis, clinical implications, and future directions". Mayo Clin Proc (Review). 92 (11): 1723–36. doi:10.1016/j.mayocp.2017.09.007. PMC 6095693. PMID 29101940. Archived from the original on July 20, 2021. Retrieved July 21, 2020.
  19. ^ McKeith IG et al. (2017), sec. "Clinical management", pp. 93–95.
  20. ^ Taylor JP et al. (2020), sec. "Neuropsychiatric symptoms".
  21. ^ Boot BP (2015), sec. "Introduction".
  22. ^ Tahami Monfared AA, Meier G, Perry R, Joe D (December 2019). "Burden of disease and durrent management of dementia with Lewy bodies: a literature review". Neurol Ther (Review). 8 (2): 289–305. doi:10.1007/s40120-019-00154-7. PMC 6858913. PMID 31512165.
  23. ^ Asada T, Chapter 2 in Kosaka K, ed. (2017), p. 11.
  24. ^ Asada T, Chapter 2 in Kosaka K, ed. (2017), p. 12.
  25. ^ Armstrong MJ (February 2019). "Lewy Body Dementias". Continuum (Minneap Minn) (Review). 25 (1): 128–46. doi:10.1212/CON.0000000000000685. PMID 30707190.
  26. ^ Weil RS, Lashley TL, Bras J, Schrag AE, Schott JM (2017). "Current concepts and controversies in the pathogenesis of Parkinson's disease dementia and dementia with Lewy bodies". F1000Res (Review). 6: 1604. doi:10.12688/f1000research.11725.1. PMC 5580419. PMID 28928962.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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