What is dementia with Lewy bodies?
Dementia with Lewy bodies (DLB) refers to a progressive neurological disorder. It is the second most common type of dementia.
The pathological hallmarks of dementia with Lewy bodies are inclusions of alpha-synuclein. This buildup of alpha-synuclein is called a Lewy body.
These Lewy bodies are found in the brainstem nuclei and neocortex, where they contribute to neuronal loss of both glial cells and neurons [1, 2, 3]. The loss of cells and neurons causes various symptoms, most notably cognitive decline. Before examining the 7 stages of Lewy Body dementia, let us take a closer look at these symptoms.
Lewy Bodies Dementia Symptoms
The clinical manifestation of dementia with Lewy bodies overlaps with other types of dementia, such as Alzheimer’s disease [3].
Lewy Bodies dementia symptoms include neuropsychiatric and motor symptoms [4, 5]. The cognitive symptoms include:
- Visual hallucinations - This is the key clinical symptom of patients with Lewy Body Dementia.
- Memory loss - Patients may experience memory issues.
- Cognitive decline - Patients with DLB can have impaired speech, language difficulties or show disorientation.
- Daytime sleepiness - We observe excessive daytime sleepiness in patients with dementia with Lewy Bodies. In addition, patients may experience sleep behaviour disorder.
The motor symptoms are usually manifested similarly to what we observe in Parkinson’s disease:
- Balance issues - The patient may experience problems with balance or posture.
- Problems with hand dexterity - The patient may experience difficulties with using hands in a coordinated way, for example when grasping an object.
- Tremor - The patient may experience involuntary shaking of a limb at rest.
- Rigidity - Rigidity is characterized by stiffness experienced when moving limbs.
What are the 7 stages of Lewy Body Dementia?
Dementia with Lewy bodies is a progressive neurodegenerative disorder. Thus from its progressive nature, there are different stages of the disease. Here we provide an overview of 7 stages of dementia with Lewy bodies.
The 7 Stages of Lewy Body Dementia
Stage 1: Normal
In this stage, the patient nor the loved ones notice cognitive decline. The patient with DLB is normal. However, some patients may experience daytime sleeping with hallucinations.
Stage 2: Mild Cognitive Impairment
The patient or the loved ones may notice mild memory loss and slight cognitive changes. The patient may show minor memory issues such as forgetting names or experiencing trouble with locating objects. However, they are capable of continuing their daily activities.
Stage 3: Moderate Cognitive Decline
In addition to the symptoms from stage 2 (forgetfulness, problems with locating objects) being more apparent, the patient also shows problems with concentration.
Stage 4: Severe Cognitive Decline
The patient usually gets diagnosed in this stage. We observe significant memory loss, the symptoms worsen and represent a life-disturbing cognitive decline. The patient has an increased risk of falls and requires supervision in daily activities.
Stage 5: Motor symptoms
The motor symptoms appear in this stage. This includes tremors, rigidity and the patient may experience difficulty in speaking. In addition, the patient is unable to perform simple tasks and requires daily care.
Stage 6: Psychiatric symptoms and delusions
In addition to the motor symptoms, the patient may become paranoid and experience delusions. Memory loss is significant and the patient may completely lose the ability to speak. These patients are at high risk of infections and require 24-hour care.
Stage 7: End-stage of Dementia with Lewy Bodies
The patient loses the ability to walk and we observe very severe cognitive decline. This period typically lasts 1.5-2.5 years and the patient requires constant care with all activities.
Treatment for Lewy Body Dementia
Medical treatment for dementia with Lewy Bodies can help manage some of the symptoms, but does not treat the underlying cause of the disease. Furthermore, there is currently a lack of DLB-specific treatment. The available treatment comes from clinical trials on Alzheimer’s disease or Parkinson’s disease patients. Some examples of the available treatment include [6, 7, 8]:
- Cholinesterase inhibitors - Cholinesterase inhibitors such as rivastigmine or galantamine can help with cognitive and behavioural symptoms.
- L-Dopa - L-Dopa helps with managing motor symptoms and is a common treatment for Parkinson’s disease.
- Clozapine - Clozapine can be effective in managing neuropsychiatric symptoms.