How is it different from other dementias?
In Alzheimer's disease, memory impairment for recent events comes to the fore, and movement disorders appear late. In dementia with Lewy bodies, memory may initially suffer moderately, but attention, visuospatial abilities, and speed of thinking are severely impaired. Relatives describe that the person is almost the same, then for several hours he becomes detached and confused. This form is also distinguished by the early appearance of stiffness, a shuffling gait, as well as a special sleep disorder in which a person seems to be acting out dreams.
- Fluctuations during the day and from day to day
- Visual hallucinations, often images of people and animals
- Parkinsonism: stiffness, slowness, shuffling gait
- REM sleep behavior disorder
- Frequent falls and episodes of brief loss of consciousness
- Fluctuations in blood pressure and constipation
Early signs to look out for
Often, years before a noticeable decrease in memory, restless sleep appears: a person talks loudly, screams, waves his arms, or may fall out of bed. This REM sleep behavior disorder is considered one of the earliest warning signs. Also alarming are unexplained fainting, persistent constipation, decreased sense of smell, episodes of freezing and absent-mindedness. The appearance of visual hallucinations in an elderly person without an obvious reason is always a reason to consult a neurologist, and not to independently prescribe sedatives.
- Screams and active movements during sleep
- Decreased sense of smell
- Persistent constipation
- Fainting and dizziness when standing up
- Episodes of freezing and distraction
- Changes in handwriting and small steps when walking
Diagnostics
The diagnosis is made clinically, based on a combination of characteristic signs, confirmed by conversation with relatives: they are the ones who notice fluctuations in the state and characteristics of sleep. Neuropsychological testing is carried out, which reveals a typical profile of impairments with a predominance of visuospatial disorders. MRI of the brain helps exclude vascular lesions, tumors and hydrocephalus. Be sure to check for conditions that can mimic dementia: hypothyroidism, vitamin B12 deficiency, depression, side effects of medications.
- Detailed interview with the patient and relatives
- Neuropsychological testing
- MRI of the brain
- EEG during episodes of confusion
- TSH, vitamin B12, general and biochemical blood test
- Review of all medications taken
Treatment
There is no specific treatment to stop the disease yet, but many symptoms can be corrected. Medicines used for Alzheimer's disease often produce marked improvements in attention and hallucinations. In case of movement disorders, antiparkinsonian drugs are carefully selected, remembering that they can intensify hallucinations. Sleep requires special attention. Key safety rule: in this form of dementia, a number of classic antipsychotics can cause severe deterioration with immobility and confusion, so any psychotropic drugs should only be prescribed by a doctor who knows the diagnosis.
- Drugs to improve cognitive function as prescribed by a doctor
- Careful selection of antiparkinsonian drugs
- Correction of sleep disorders
- Prohibition on self-use of antipsychotics
- Treatment of orthostatic hypotension and constipation
- Regular physical activity and sessions with a speech therapist
- Informing all doctors about the diagnosis before any appointments
Help and safety at home
It is important for relatives to understand that fluctuations in condition are part of the disease, and not pretense or laziness. Hallucinations, if they do not frighten a person, do not always require medication: it is often enough to calmly explain and switch attention, improve lighting, remove mirrors and objects with ambiguous outlines. Because of stiffness and falls, the home needs to be made safe. A clear daily routine, familiar surroundings, and feasible activity are helpful. Caregivers need their own support: burnout of loved ones is a common and serious problem.
- Good lighting and no glare
- Remove carpets, thresholds and wires to prevent falls
- Handrails in the bathroom and toilet
- A clear daily routine and familiar guidelines
- Calmly responding to hallucinations
- Safe sleeping place during sleep activity
- Support and rest for caregivers