Post by Neo on Jan 19, 2005 21:25:46 GMT -5
Attributed to Norbert
FAQ3 - Diagnosing Lewy Body 04/01/04 02:57 PM
Lewy body is the second most common type of dementia - estimated at 15-25% (Alzheimers is responsible for about 60%) Vascular dementia has slipped to the third place now that doctors are more careful about heart health and treating high blood pressure.
There is no single test to determine Lewy body disease. The diagnosis in clinical, meaning the doctor makes the diagnosis because symptoms and progression is characteristic of Lewy body.
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from lewynet, information page:
Clinical diagnostic criteria have recently been assembled at a recent Consortium meeting to produce a new set of criteria (McKeith et al, 1996).
1. The central requirement is progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function. Prominent or persistent memory impairment may not necessarily occur in the early stages but is usually evident with progression. Deficits on tests of attention and frontal-sub-cortical skills and visuospatial ability may be especially prominent.
2. Two of the following are required for a probable, and one for a possible diagnosis of dementia with Lewy bodies:
o Fluctuating cognition with pronounced variations in attention and alertness
o Recurrent visual hallucinations which are typically well-formed and detailed
o Spontaneous motor features of parkinsonism
3. Features supportive of the diagnosis are:
o Repeated falls
o Syncope or transient loss of consciousness
o Neuroleptic sensitivity
o Systematised delusions
o Hallucinations in other modalities
4. A diagnosis of dementia with Lewy bodies is less likely in the presence of:
o Stroke disease, evident as focal neurological signs or on brain imaging
o Evidence on physical examination and investigation of any physical illness or other brain disorder sufficient to account for the clinical picture
The core feature of DLB is a progressive dementia.
• Clinically, this condition can present as a dementia which is often initially diagnosed as either Alzheimer's disease or vascular dementia.
• Alternatively, many patients start with classical Parkinson's disease and later go on to develop dementia.
• Only a minority of patients present with the simultaneous onset of both dementia and parkinsonism
A combination of key clinical features has allowed workers in many centers to diagnose this condition and distinguish it from other causes of dementia.
• Most patients initially complain of impaired recent memory.
• In other patients the main problem is behavioral disturbance with preserved memory.
• Speech block, problems with word-finding, visuospatial difficulties (such as problems in following an unfamiliar route) may happen early in the disease.
• Features, such as inattention, mental inflexibility, indecisiveness and lack of judgement, together with loss of insight, may also develop in the early stages of the disease and are useful in suggesting the possibility of a non-Alzheimer form of dementia.
• An important feature which helps to distinguish DLB from Alzheimer's disease is the presence of striking fluctuations in cognitive performance during the early stages of the disease. By way of example, one day a patient may be able to hold a sustained conversation, the next they may be drowsy, inattentive and almost mute. Some patients have periods of frank stupor, which often causes clinicians to search (in vain) for an intercurrent diseases such as infection or stroke. The basis of these fluctuations is not clear.
• Another very characteristic clinical feature is the presence of visual hallucinations. The hallucinations are typically complex and detailed. For example, patients may see images of people or animals that they recognise. Some patients see coloured patterns or shapes. Interestingly, the hallucinations are not always distressing to patients and many learn to distinguish between real and unreal images: some people actually come to enjoy them. In many patients visual hallucinations are accompanied by delusions which tend to have a persecutory theme.
• A third characteristic clinical feature is the presence of clinical features of parkinson's disease. These develop spontaneously in most patients who have initially presented with dementia, and may be relatively mild. The typical features are
o a flexed posture
o a shuffling gait
o reduced armswing
o a tendency to falls.
o a paucity of spontaneous movement
o Tremor is the least common parkinsonian feature in patients who have presented with dementia.
• Myoclonus, is common. It is usually mild, spontaneous and multifocal. Some patients have very prominent myoclonus early in disease, and this can raise concerns about the possibility of Creutzfeldt-Jakob disease (CJD).
• Patients with DLB are often abnormally sensitive to neuroleptic therapy, developing parkinsonism even if they have not shown such signs before drug administration. The associated parkinsonism is often prolonged, profound and may even be fatal.
This information was found at www.nottingham.ac.uk/pathology/lewy/lewyinfo.html
Obviously, it takes a dementia specialist to recognize the difference between Alzheimers and Lewy, especially then there is a mix of dementias.
further resources -
A comprehensive (and perhaps easier to read) fact sheet “Dementia with Lewy Bodies” can be found at Family Caregiver Alliance
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=570
There are a number of information articles on DLB at Alzheimers outreach, in the "Other Dementias" section.
www.zarcrom.com/users/alzheimers/odem/lewy-d.html
Article in American Family Physician April 6, 2006
Dementia with Lewy Bodies: An Emerging Disease
www.aafp.org/afp/20060401/1223.html
Patient handout from above article
www.aafp.org/afp/20060401/1230ph.html
Lewy Body Dementia Association
www.lewybodydementia.org/
According to Neo - In my case, I've learned a lot from the LBD forum on Yahoo I belong to:
health.groups.yahoo.com/group/LBDcaregivers/
FAQ3 - Diagnosing Lewy Body 04/01/04 02:57 PM
Lewy body is the second most common type of dementia - estimated at 15-25% (Alzheimers is responsible for about 60%) Vascular dementia has slipped to the third place now that doctors are more careful about heart health and treating high blood pressure.
There is no single test to determine Lewy body disease. The diagnosis in clinical, meaning the doctor makes the diagnosis because symptoms and progression is characteristic of Lewy body.
-----------------
from lewynet, information page:
Clinical diagnostic criteria have recently been assembled at a recent Consortium meeting to produce a new set of criteria (McKeith et al, 1996).
1. The central requirement is progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function. Prominent or persistent memory impairment may not necessarily occur in the early stages but is usually evident with progression. Deficits on tests of attention and frontal-sub-cortical skills and visuospatial ability may be especially prominent.
2. Two of the following are required for a probable, and one for a possible diagnosis of dementia with Lewy bodies:
o Fluctuating cognition with pronounced variations in attention and alertness
o Recurrent visual hallucinations which are typically well-formed and detailed
o Spontaneous motor features of parkinsonism
3. Features supportive of the diagnosis are:
o Repeated falls
o Syncope or transient loss of consciousness
o Neuroleptic sensitivity
o Systematised delusions
o Hallucinations in other modalities
4. A diagnosis of dementia with Lewy bodies is less likely in the presence of:
o Stroke disease, evident as focal neurological signs or on brain imaging
o Evidence on physical examination and investigation of any physical illness or other brain disorder sufficient to account for the clinical picture
The core feature of DLB is a progressive dementia.
• Clinically, this condition can present as a dementia which is often initially diagnosed as either Alzheimer's disease or vascular dementia.
• Alternatively, many patients start with classical Parkinson's disease and later go on to develop dementia.
• Only a minority of patients present with the simultaneous onset of both dementia and parkinsonism
A combination of key clinical features has allowed workers in many centers to diagnose this condition and distinguish it from other causes of dementia.
• Most patients initially complain of impaired recent memory.
• In other patients the main problem is behavioral disturbance with preserved memory.
• Speech block, problems with word-finding, visuospatial difficulties (such as problems in following an unfamiliar route) may happen early in the disease.
• Features, such as inattention, mental inflexibility, indecisiveness and lack of judgement, together with loss of insight, may also develop in the early stages of the disease and are useful in suggesting the possibility of a non-Alzheimer form of dementia.
• An important feature which helps to distinguish DLB from Alzheimer's disease is the presence of striking fluctuations in cognitive performance during the early stages of the disease. By way of example, one day a patient may be able to hold a sustained conversation, the next they may be drowsy, inattentive and almost mute. Some patients have periods of frank stupor, which often causes clinicians to search (in vain) for an intercurrent diseases such as infection or stroke. The basis of these fluctuations is not clear.
• Another very characteristic clinical feature is the presence of visual hallucinations. The hallucinations are typically complex and detailed. For example, patients may see images of people or animals that they recognise. Some patients see coloured patterns or shapes. Interestingly, the hallucinations are not always distressing to patients and many learn to distinguish between real and unreal images: some people actually come to enjoy them. In many patients visual hallucinations are accompanied by delusions which tend to have a persecutory theme.
• A third characteristic clinical feature is the presence of clinical features of parkinson's disease. These develop spontaneously in most patients who have initially presented with dementia, and may be relatively mild. The typical features are
o a flexed posture
o a shuffling gait
o reduced armswing
o a tendency to falls.
o a paucity of spontaneous movement
o Tremor is the least common parkinsonian feature in patients who have presented with dementia.
• Myoclonus, is common. It is usually mild, spontaneous and multifocal. Some patients have very prominent myoclonus early in disease, and this can raise concerns about the possibility of Creutzfeldt-Jakob disease (CJD).
• Patients with DLB are often abnormally sensitive to neuroleptic therapy, developing parkinsonism even if they have not shown such signs before drug administration. The associated parkinsonism is often prolonged, profound and may even be fatal.
This information was found at www.nottingham.ac.uk/pathology/lewy/lewyinfo.html
Obviously, it takes a dementia specialist to recognize the difference between Alzheimers and Lewy, especially then there is a mix of dementias.
further resources -
A comprehensive (and perhaps easier to read) fact sheet “Dementia with Lewy Bodies” can be found at Family Caregiver Alliance
www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=570
There are a number of information articles on DLB at Alzheimers outreach, in the "Other Dementias" section.
www.zarcrom.com/users/alzheimers/odem/lewy-d.html
Article in American Family Physician April 6, 2006
Dementia with Lewy Bodies: An Emerging Disease
www.aafp.org/afp/20060401/1223.html
Patient handout from above article
www.aafp.org/afp/20060401/1230ph.html
Lewy Body Dementia Association
www.lewybodydementia.org/
According to Neo - In my case, I've learned a lot from the LBD forum on Yahoo I belong to:
health.groups.yahoo.com/group/LBDcaregivers/
hugs, Deb
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : ) 