Symtom – Lewy Body Dementia Resource Center

Enligt National Institutes of Health, Pub No. 15-7907 och:

https://www.nia.nih.gov/health/what-lewy-body-dementia#signs

Symtom som skiljer Lewy body-demens från andra demenssjukdomar kan vara:

synhallucinationer tidigt i sjukdomsförloppet
variationer i kognitiv förmåga, uppmärksamhet och vakenhet
långsamma rörelser, gångsvårigheter eller stelhet (parkinsonism)
känslighet för läkemedel som används för att behandla hallucinationer
REM-sömnstörning, där personen fysiskt lever ut sina drömmar genom att skrika, fäkta, slå sällskap i sängen och ramla ur sängen
större svårigheter med komplexa mentala aktiviteter, såsom att göra flera saker samtidigt, problemlösning och analytiskt tänkande, än med minnet

Personer med LBD kanske inte har alla LBD-symtom, och hur svåra symtomen är kan variera mycket från person till person. Under sjukdomsförloppet bör alla plötsliga eller stora förändringar i funktionsförmåga eller beteende rapporteras till en läkare. De vanligaste symtomen innefattar förändringar i kognition, rörelse, sömn och beteende.

Kognitiva symtom

LBD orsakar förändringar i tankeförmågan. Dessa förändringar kan innefatta:

Demens – Svår förlust av tankeförmåga som för 가수 personens förmåga att utföra dagliga aktiviteter. Demens är ett primärt symtom vid LBD och innefattar oftast problem med visuella och spatiala förmågor (att bedöma avstånd och djup eller misskänna föremål), planering, att göra flera saker samtidigt, problemlösning och resonemang. Minnesproblem kanske inte märks först men uppstår ofta i takt med att LBD fortskrider. Demens kan också innefatta förändringar i humör och beteende, dåligt omdöme, förlust av initiativförmåga, förvirring kring tid och plats samt svårigheter med språk och siffror.
Kognitiva fluktuationer – Oförutsägbara förändringar i koncentration, uppmärksamhet, vakenhet och vakenhet från dag till dag och ibland under dagen. En person med LBD kan stirra ut i luften under längre stunder, verka dsig och letargisk, eller sova flera timmar under dagen trots att hen har fått tillräckligt med sömn på natten. Tankeflödet kan ibland vara oorganiserat, oklart eller ologiskt. Personen kan verka bättre en dag och sedan sämre nästa dag. Dessa kognitiva fluktuationer är vanliga vid LBD men är inte alltid enkla för en läkare att identifiera.
Hallucinationer – Att se eller höra saker som inte finns där. Synhallucinationer förekommer hos upp till 80 procent av personer med LBD, ofta tidigt i förloppet. De är vanligtvis realistiska och detaljerade, som bilder av barn eller djur. Hörselhallucinationer är mindre vanliga än synhallucinationer men kan också förekomma. Hallucinationer som inte är störande kanske inte kräver behandling. Om de däremot är skrämmande eller farliga (till exempel om personen försöker slå en upplevd inkräktare) kan en läkare skriva ut läkemedel.

Rörelsesymtom

Vissa personer med Lewy body-demens kanske inte upplever märkbara rörelseproblem på flera år. Andra kan få dem tidigt. Till en början kan tecken på rörelseproblem, såsom en förändring i handstilen, vara mycket milda och därför förbises. Parkinsonism ses tidigt vid demens med Lewy bodies vid Parkinsons sjukdom, men kan också utvecklas senare vid demens med Lewy-kroppar. Särskilda tecken på parkinsonism kan innefatta:

muskelstelhet eller kramp
släpande gång, långsamma rörelser eller stel hållning
tremor eller skakningar, oftast i vila
balansproblem och fallolyckor
framåtlutad hållning
förlorad koordination
mindre handstil än vad som var brukligt för personen
minskat ansiktsuttryck
svårigheter att svälja
svag röst

Sömnstörningar

Sleep disorders are common in people with Lewy body dementia but are often undiagnosed. A sleep specialist can play an important role on a treatment team, helping to diagnose and treat sleep disorders. Sleep-related disorders seen in people with LBD may include:

REM sleep behavior disorder—A condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one’s sleep, violent movements, or falling out of bed. Sometimes only the bed partner of the person with LBD is aware of these symptoms. REM sleep behavior disorder appears in some people years before other LBD symptoms.
Excessive daytime sleepiness—Sleeping 2 or more hours during the day.
Insomnia—Difficulty falling or staying asleep, or waking up too early.
Restless leg syndrome—A condition in which a person, while resting, feels the urge to move his or her legs to stop unpleasant or unusual sensations. Walking or moving usually relieves the discomfort.

Behavioral and Mood Symptoms

Changes in behavior and mood are possible in Lewy body dementia. These changes may include:

Depression—A persistent feeling of sadness, inability to enjoy activities, or trouble with sleeping, eating, and other normal activities.
Apathy—A lack of interest in normal daily activities or events; less social interaction.
Anxiety—Intense apprehension, uncertainty, or fear about a future event or situation. A person may ask the same questions over and over or be angry or fearful when a loved one is not present.
Agitation—Restlessness, as seen by pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability.
Delusions—Strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living. Another delusion that may be seen in people with LBD is Capgras syndrome, in which the person believes a relative or friend has been replaced by an imposter.
Paranoia—An extreme, irrational distrust of others, such as suspicion that people are taking or hiding things.

Other LBD Symptoms

People with LBD can also experience significant changes in the part of the nervous system that regulates automatic functions such as those of the heart, glands, and muscles. The person may have:

changes in body temperature
problems with blood pressure
dizziness
fainting
frequent falls
sensitivity to heat and cold
sexual dysfunction
urinary incontinence
constipation
a poor sense of smell

A BETTER UNDERSTANDING OF SOME SYMPTOMS

The following information from the Parkinson’s Disease Foundation is extremely helpful to get a better understanding of many symptoms. As a reminder, Lewy body dementia is an umbrella term for two related diagnoses. It refers to both Parkinson’s disease dementia and dementia with Lewy bodies. Note that some people with LBD may have a mixture of Alzheimer’s disease as well, so symptoms and understanding may vary.

Types of Cognitive Difficulties in PD

PD affects a variety of cognitive functions. Problems with executive function are often regarded as the most common. However, some people may undergo memory problems more significantly, while others will experience a mixture of difficulties. Most people retain their general intellectual abilities and knowledge as well as the short and long-term memories they acquired prior to the onset of PD.

Executive dysfunction: Executive functions are higher-order mental processes such as problem-solving and planning, initiating and following through on tasks, and multi-tasking ideas or projects. For a person with PD, paying bills or even taking part in group conversations can be difficult. Why? It’s because these activities require a person to be flexible and be able to shift from one category of information or one specific goal to another. People with PD may describe getting overwhelmed or ‘freezing’ in situations that require the formulation of a series of strategic choices, yet they appear to function perfectly when someone else helps them initiate and persist with a task. In the absence of some sort of “intellectual scaffolding,” it is more efficient for the person with PD to focus on one goal or concept at a time. An example is a person who was unable to initiate a project to clean his messy basement, but who successfully completed the task after his wife provided structure and cues by breaking down the task into parts and providing explicit instructions that focused on one single area at a time.

Memory disturbances: Remembering information that has already been learned is the most common difficulty for those with PD and can be improved through use of memory cues. For a person with PD to effectively learn and retain new information, repetition may be needed. PD-D affects both short-term and long-term memory functions more severely.

Attention difficulties: As the complexity of a situation increases, it can be difficult for a person with PD to maintain his or her focus or divide his or her attention. For example, patients may find they can no longer “walk and chew gum at the same time.” This affects intellectual pursuits and everyday activities such as walking, maintaining balance, and carrying on a conversation.

Bradyphrenia (slowed mental processing): People with PD say that the disease affects how quickly they can process and respond to information. Slowness in information processing impacts both other cognitive processes (such as problem-solving and retrieving information) and daily activities (such as conversing).

Language dysfunction: The most common language-related difficulty for people with PD is word-finding. As a person’s PD progresses, he or she may also experience problems with naming or mis-naming, may have difficulty comprehending complex information, and may use more simplified and less spontaneous speech.

Visual-spatial disturbances: Trouble perceiving, processing, discriminating, and acting on visual information in the environment can affect daily life. For example, it may become difficult to navigate around the house or estimate distances when reaching for something, thereby increasing the risk of falls. In some cases, visual-spatial impairment in PD may also lead to visual misperceptions, or illusions.

Causes of Cognitive Changes in PD

Our understanding of the causes of cognitive changes in PD is incomplete. We do know that problems with cognition are related to the same underlying brain changes that result in motor symptoms — that is, premature death of nerve cells, changes in brain neurochemistry, and subsequent alterations in brain circuitry between different brain regions. In addition, Lewy bodies, the abnormal collections of proteins that are found in nerve cells in PD, are related to changes in motor pathways and to pathways affecting cognitive processes.

Other elements can cause and aggravate cognitive difficulties. Untreated depression, anxiety, psychosis, sleep, and other behavioral difficulties can exacerbate cognitive difficulties. In addition, some medications, whether for PD or other conditions, can cause negative cognitive effects as can some non-PD-related general medical conditions, such as infections.

MOVEMENT – further information from the Parkinson’s Disease Foundation:

Bradykinesia:Bradykinesia means “slow movement.” A defining feature of Parkinson’s, bradykinesia also describes a general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressivity. Bradykinesia causes difficulty with repetitive movements, such as finger tapping. Due to bradykinesia, a person with Parkinson’s may have difficulty performing everyday functions, such as buttoning a shirt, cutting food or brushing his or her teeth. People who experience bradykinesia may walk with short, shuffling steps. The reduction in movement and the limited range of movement caused by bradykinesia can affect a person’s speech, which may become quieter and less distinct as Parkinson’s progresses. https://www.parkinson.org/

Prognosis

Per National Institutes of Health:

Lewy body dementia is a progressive disease, meaning symptoms start slowly and worsen over time. The disease lasts an average of 5 to 7 years from the time of diagnosis to death, but the time span can range from 2 to 20 years. How quickly symptoms develop and change varies greatly from person to person, depending on overall health, age, and severity of symptoms. In the early stages of LBD, usually before a diagnosis is made, symptoms can be mild, and people can function fairly normally. As the disease advances, people with LBD require more and more help due to a decline in thinking and movement abilities. In the later stages of the disease, they may depend entirely on others for assistance and care.–https://www.nia.nih.gov/alzheimers/publication/lewy-body-dementia/basics-lewy-body-dementia

Genetics: While having a family member with LBD may increase a person’s risk, LBD is not normally considered a genetic disease.