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Dementias
Dementia with lewy bodies
Dementia with Lewy bodies (DLB) is a cause of dementia very similar to Alzheimer's disease. A very similar dementia can develop in people who have had Parkinson's disease for a number of years. DLB differs both in the precise nature of the symptoms and in the damage that is found in the brain after death from Alzheimer's disease. The disease gets its name because of the deposits which are found in the brain after death (named after the doctor who first wrote about them). Lewy bodies are round deposits which contain damaged nerve cells. They are probably formed as the cells try to protect themselves from attack.
Dementia with Lewy bodies can result in:
For people with this form of dementia, hallucinations, for example seeing a person or pet on a bed or a chair when nothing is there, can be particularly distressing and problematic.
They usually develop some Parkinson's disease-type symptoms such as slowness of movement, stiffness and tremor. In a few cases heart rate and blood pressure are affected. The abilities of the affected person often fluctuate from hour to hour, and over weeks and months. This sometimes causes carers to think that the person is putting on their confusion.
It is possible that some people suffer from both Alzheimer's disease and Dementia with Lewy bodies.
Similarly to what happens in Alzheimer's disease, production of numerous chemical messengers, including acetylcholine and glutamate, are disrupted as nerve ends are attacked and cells die. The loss of the cholinergic system (nerves with acetylcholine as the messenger) is particularly pronounced in DLB patients. DLB patients also have a loss of the messenger dopamine in one of the parts of the brain that controls motor movement.
Several studies (mostly using the drug exelon) show that people with DLB and with dementia developing after Parkinson's Disease respond very well to cholinesterase inhibitor treatment. Drugs given to improve symptoms of Parkinson's disease may help the motor symptoms, but have to be used cautiously as they can worsen hallucinations in some people. It is also important to avoid harm, as people with DLB are particularly sensitive to neuroleptic tranquilliser drugs (which are often prescribed for visual hallucinations or behavioural symptoms), which can cause severe side-effects, or even death.
Inheritance patterns
A lot is now known about genetic factors which may be important for the development of Parkinson's disease. These are now being investigated to see whether they are also important for the development of DLB. As is the case for Alzheimer's disease, in the wider community there is a genetic risk linked to the ApoE4 gene.
Prenatal diagnosis
None
Vascular dementia
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