Dementia with Lewy Bodies and Its Treatment

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Topic: Health & Medicine
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Abstract

With the increase of life expectancy, the number of people suffering from age-related diseases has also increased. Dementia syndrome is admittedly one of such disorders. Dementia can be caused by different factors that influence the specifics of the disease’s development. It is obvious that special attention must be paid to the investigation of these factors and particular kinds of dementia. This paper is devoted to dementia with Lewy bodies (DLB).

The definition of dementias and information about their classification is given in order to determine the place of DLB in their system. Other dementia types are briefly described in the paper. DLB is characterized from the point of view of its symptoms and its treatment. A conclusion is made regarding the significance of studies devoted to DLB and other dementia types. It is suggested that there is still room for research when the disease is concerned.

Introduction

The rapidly aging population of Earth has faced the epidemic of age-associated diseases, one of which is admittedly dementia. For example, by the 2005 the yearly incidence of dementia of different kinds was almost 5 million cases. According to Mandell and Green (2011), the term “dementia” used to be confused with Alzheimer’s disease (AD).

Nowadays, however, it is obvious that that dementia can be caused by different factors which influence the specifics of the course of the disease’s development. Therefore, special attention is paid to the investigation of these factors and the diseases caused by them.

Since modern medical science cannot offer a cure for most of its types, dementia poses a great challenge. This paper is devoted to dementias and the ways of treating them. Particular attention is paid to dementia with Lewy bodies (DLB). While DLB is not as widespread as AD, it is still a frequent cause of dementia, which has attracted scientists’ attention to the investigation of ways of its treatment.

Dementias: Common Characteristics

According to Mandeel and Green (2011), dementia is “a syndrome of acquired persistent intellectual impairments characterized by deterioration in at least three of the following domains: memory, language, visuospatial skills, personality or behavior, and manipulation of acquired knowledge (including executive function)” (p. 6).

As the definition demonstrates, dementia can manifest in numerous ways and it is not a diagnostic term. It is known that the syndrome can be a result of many different reasons that have become the basis for dementia types classification.

The most common type of the disease (it accounts for 55-75% of dementia in the world) is AD: “a degenerative brain disorder characterized by progressive intellectual and behavioral deterioration that is heralded, and usually dominated by, memory disorder, with prominent visuospatial and language impairment in the context, at least early in the course, of preserved social skills” (Mandell & Green, 2011, p. 13).

Other types of dementia include two groups of diseases: vascular dementia (VD) and DLB. VD is of vascular origin and it includes diseases like post-stroke dementia, multi-infarct dementia and Binswanger’s disease, which is a result of the occlusion of small blood vessels. The reasons that cause this kind of dementia determine the necessity of leading a healthy lifestyle for the patients (Shastri, Bonifati, & Kishore, 2013).

Just like VD, DLB is not a single disease but a group of diseases that will be enumerated later. Treatments for the above-mentioned dementias (for example, cholinesterase inhibitors) do exist, but there is no cure. It is mostly the symptoms of these kinds of dementia that are treated (Shastri et al, 2013).

Frontotemporal dementia is a type of dementia with the involvement of the frontal and temporal lobes of brain that is characterized by “insidious onset, decline in personal and social conduct as well as early emotional blunting and loss of insight” (Shastri et al., 2013, p. 330). No known treatment for this kind of dementia exists.

Apart from that, one may mention the variants of dementia that are connected with other diseases, for example, AIDS. According to Shastri et al. (2013), HIV-associated dementia is a particularly severe neurocognitive disorder (p. 333). However, the highly active antiretroviral therapy has been proven to be effective both in preventing its development and in treating it after its manifestation (Shastri et al., 2013, p. 334).

We may conclude that the causes of dementia types do not only define their development but also affect the choice of proper treatment.

Definition

DLB is a group of dementias similar to AD as it is another very common degenerative brain disorder. This term covers several specific diseases: “diffuse LB disease, LB dementia, dementia associated with cortical Lewy bodies, the LB variant of Alzheimer’s disease, the senile dementia of LB type” (McKeith, 2010, p. 597). The Lewy bodies, anomalous neural inclusions that are characteristic of this group of diseases, were first discovered in 1989.

The severity of this dementia type has been proven to correlate with the presence of the bodies, but they still can only be discovered postmortem (Mayo & Bordelon, 2014). No specific diagnostic tests exist for this type of dementia, but examining the physical and mental state of a patient along with analyzing his history is needed. The prognosis may depend on the initial health and can be similar to or more severe than that of AD (Shastri et al., 2013).

Symptoms

The main symptoms of DLB are the “fluctuating cognition, recurrent and persistent visual hallucinations, parkinsonism” (Riverol & Lopez, 2015, p. 181). Other relevant signs may include depression, anxiety or apathy as well as sleep disorders (Mayo & Bordelon, 2014; Bhat & Rockwood, 2011). Memory deterioration becomes more noticeable as the disease progresses (Mayo & Bordelon, 2014).

Treatment

While no cure has been offered for DLB, its symptoms can be treated (Byrne & O’Brien, 2010). Maoy and Bordelon (2014) have carried out a research concerning the drugs used for this purpose. According to these authors, cholinesterase inhibitors (donepezil, rivastigmine) have been used to solve behavioral issues like apathy and to address the problem of hallucinations in certain cases.

Serotonin has been used to treat depression while dopaminergic agents have been used to alleviate parkinsonism. According to Mayo and Bordelon (2014), all the mentioned treatments may have side effects, some of which include aggravating the symptoms treated or other DLB symptoms. Further investigation in this direction is being carried out.

Conclusion

DLB is a very common brain degenerative disorder, second only to AD. As the reasons for its onset are completely different from those of other dementia types, separate investigation of its nature is being carried out. Current medical science can offer treatment for the symptoms of DLB that may cause grave side effects. All of this emphasizes the importance of further research on the matter devoted to the search for a better treatment or cure.

Dementia of any origin is believed to be incurable and irreversible, but certain processes that cause dementia can be treated (Mandell & Green, 2011). While the treatment of dementia symptoms along with palliative therapy is of extreme importance, attempts at finding the ways of curing dementias are being made. Taking into account the fact that the population of the Earth is aging, the importance of related studies can hardly be overestimated.

References

Bhat, R., & Rockwood, K. (2011). Psychiatric Complications of Dementia. Canadian Journal of Psychiatry, 56(7), 398-407.

Byrne, E., & O’Brien, J. (2010). The Treatment of Dementia with Lewy Bodies. In J. O’Brien, D. Ames & A. Burns (Eds.), Dementia (4th ed., pp. 619-629). London, UK: Hodder Arnold.

Mandell, A., & Green, R. (2011). Alzheimer’s Disease. In A. Budson & N. Kowall, The handbook of Alzheimer’s disease and other dementias (pp. 131-145). Chichester, West Sussex, UK: Wiley-Blackwell.

Mayo, M., & Bordelon, Y. (2014). Dementia with Lewy Bodies. Seminars in Neurology, 34(02), 182-188. doi:10.1055/s-0034-1381741

McKeith, I. (2010). Dementia with Lewy Bodies: a Clinical and Historical Overview. In J. O’Brien, D. Ames & A. Burns, Dementia (4th ed., pp. 597-608). London, UK: Hodder Arnold.

Riverol, M., & Lopez, O. (2015). Dementia with Lewy Bodies. In C. Noggle, The Neuropsychology Of Cortical Dementias (pp. 175-199). New York, NY: Springer Publishing Company.

Shastri, A., Bonifati, D., & Kishore, U. (2013). Other Dementias. In U. Kishore, Neurodegenerative diseases (pp. 321-344). Rijeka, Croatia: InTech.