Lewy Body Dementia – Diagnosis and Treatment
Diagnosis
Neurological and Body Function Evaluation
Doctors examine reflexes, muscle strength, and walking ability. They look for muscle stiffness and tremor, which are movement issues often seen in Lewy body dementia (DLB).
Health professionals also observe eye movements and check balance to spot signs that may point to problems with the brain or nerve signals.
A physical exam helps doctors find signs that might suggest Parkinson’s disease, stroke, or other conditions. In Lewy body dementia, doctors often notice changes like slowness, trouble with coordination, and a shuffling walk.
Checking Thinking and Memory
Doctors use tests for mental abilities to measure how well a person remembers information and solves problems. They can quickly check memory loss, attention, and thinking problems with short tests.
These screenings show if someone has issues with cognitive skills, but may not separate Lewy body dementia from other conditions like Alzheimer’s.
Longer, detailed neuropsychological assessments can take several hours. These in-depth tests reveal changes in thinking patterns, alertness, and mental processing linked to DLB.
People may have trouble with problem-solving, visual tasks, or attention that can shift from day to day.
Laboratory Blood Studies
Doctors use blood tests to look for other causes of memory loss or confusion. They check for vitamin shortages, especially vitamin B-12, or problems with the thyroid gland.
When doctors find these types of problems, they can treat them, which might help the person think more clearly.
Blood tests do not find Lewy bodies or alpha-synuclein clumps, but they help doctors rule out other possible causes for symptoms.
Imaging of the Brain
Doctors use brain scans, such as MRI or CT, to look for strokes, tumors, or bleeding in the brain.
While these scans can’t directly show Lewy bodies, they reveal patterns of shrinking or brain changes sometimes seen with this neurodegenerative disorder.
Doctors also use Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) scans to measure how well brain cells work.
Some tests look for low dopamine activity, which may be seen with movement disorders and can provide clues for Lewy body dementia.
These results help doctors distinguish DLB from other diseases.
| Type of Scan | What It Checks | How It Helps DLB Diagnosis |
|---|---|---|
| MRI/CT | Structure | Rules out injuries, tumors, strokes |
| PET/SPECT (dopamine) | Function | Shows dopamine transporter loss |
| FDG PET | Metabolism | Identifies reduced brain activity |
Overnight Sleep Monitoring
People with DLB often have REM sleep behavior disorder. They may move during dreams or act them out. Doctors use a sleep study, also called polysomnography, to record brain waves, movements, and breathing at night.
If a person acts out dreams or has other sleep problems, this can support a diagnosis of Lewy body dementia. Doctors may also check the automatic control of heart rate and blood pressure, because these can also be affected.
Scanning the Heart
Doctors use myocardial scintigraphy, a special imaging test, to check blood flow to the heart.
A reduced signal in this scan can appear in people with DLB. This test is not commonly used in every country, but it is another tool for doctors to consider when symptoms are unclear.
New Research Markers
Scientists are searching for biomarkers—signals in the blood, spinal fluid, or brain—linked to Lewy bodies and alpha-synuclein, the protein found in Lewy body dementia.
These new tests are not yet widely used, but may one day help doctors spot DLB earlier, even before serious memory or movement symptoms develop.
Ways to Treat Lewy Body Dementia
Medicines to Help Symptoms
Doctors often use medication to help manage thinking and movement challenges in Lewy body dementia. Many patients begin treatment with cholinesterase inhibitors, a class of drugs that increase levels of important brain chemicals.
These medications can improve memory, alertness, and, for some people, reduce hallucinations or delusions. Possible side effects may include mild stomach upset, increased urination, muscle aches, and changes in heart rhythm.
For individuals with more severe cognitive symptoms, doctors may add an NMDA receptor antagonist to further support mental function.
To help with movement difficulties such as muscle stiffness or a shuffling gait, doctors may prescribe dopaminergic therapy (a medication that increases dopamine levels in the brain). However, this treatment can sometimes worsen confusion, hallucinations, or delusions in some patients.
Doctors may also use separate medications to address sleep problems or other symptoms. Certain medications can worsen memory, so doctors generally advise avoiding anticholinergic agents commonly found in over-the-counter sleep aids or in some treatments for urinary urgency.
If antipsychotic medication is needed for severe hallucinations or delusions, doctors may consider prescribing a low dose of a second-generation antipsychotic.
These medications are used cautiously because they can cause serious side effects such as worsened coordination, significant sedation, or even life-threatening complications. These treatments are typically reserved for situations where other strategies have not been effective.
This table lists some common medicines used:
| Medicine Type | Main Uses | Possible Side Effects |
|---|---|---|
| Cholinesterase inhibitors | Thinking, memory, hallucinations | Stomach issues, cramps, heart |
| NMDA receptor antagonist | Added benefit for thinking issues | Dizziness, headache |
| Parkinson’s drugs | Movement, stiffness, shuffling walk | More confusion or hallucinations |
| Antipsychotics (rare) | Severe hallucinations, delusions | Sedation, movement problems |
Supportive Approaches and Daily Strategies
Non-drug therapies also play a very important role. Instead of giving medicine right away for certain behaviors like hallucinations, caregivers may choose to watch and wait, especially if the person is not scared or upset by what they see.
Changing the home or caregiving environment can help. Keeping rooms simple and free of clutter cuts down on confusion. Low background noise helps the person focus.
Caregivers should avoid challenging or correcting the person too much—being supportive and reassuring helps manage stress and agitation.
Simple routines every day can help. Breaking big tasks into smaller, easy steps lets the person feel more successful. A regular schedule makes it easier for someone with Lewy body dementia to know what to expect and can lower anxiety.
A medical team, family, and support aids can help someone manage symptoms and feel safer and more comfortable at home.
Lifestyle and home remedies
Making changes at home and in daily routines may help manage Lewy body dementia. Simple, clear speech and the use of hand signals or pointing can make communication easier. Giving one instruction at a time also helps reduce confusion.
Physical activity can support movement, mood, and thinking. A basic exercise routine, even gentle walking or stretching, is helpful. Encourage daily movement and try to avoid sitting for long periods.
Exercise may help slow memory changes and improve quality of life.
Keeping the mind active is also important. Puzzles, board games, and creative hobbies like painting or music can give the brain a workout.
Social interaction, such as talking with friends or joining group activities, supports thinking skills and helps prevent isolation.
A calm and steady bedtime routine may reduce evening confusion. Turn off screens and keep lights low. Using night lights can prevent disorientation if a person wakes up in the dark.
| Tip | Benefit |
|---|---|
| Simple communication | Less confusion |
| Daily exercise | Better strength, mood |
| Brain games and hobbies | Mental stimulation |
| Social activities | Improved well-being |
| Regular sleep schedule | Fewer sleep problems |
Limiting caffeine and keeping a regular sleep pattern can also make nights easier. Doctors recommend avoiding daytime naps to help improve nighttime sleep.
Alternative medicine
Many people use different approaches to help ease dementia symptoms. Some options include:
- Listening to calming music
- Spending time with pets
- Breathing in natural scents with aromatherapy
- Getting gentle massages
These methods may help people feel more relaxed and comfortable each day.
Support and Coping
Living with Lewy body dementia brings many emotional challenges. People may feel confused, frustrated, or worried. They often face sadness, anger, and fear about the changes happening in their lives.
Families and caregivers can help by listening, encouraging open conversation, and showing patience. Letting the person know they are valued helps maintain dignity and self-respect.
Reassurance can ease distress during times of confusion or unusual thoughts. Watch for signs of falls or problems with medicines. The care team offers helpful advice.
Taking Care of Yourself
Caring for someone with Lewy body dementia can be difficult. Caregivers may feel tired, sad, or alone. Looking after your own well-being helps you continue to give good support. Here are some steps to consider:
| Self-Care Tip | Description |
|---|---|
| Ask for help | Reach out to friends or family members for support. |
| Use professional services | In-home care or respite care can lighten your daily tasks. |
| Stay active | Exercise and a healthy diet help maintain your strength. |
| Learn more | Understanding the disease can make caregiving easier. |
| Join support groups | Sharing with others can reduce stress and offer new ideas. |
Local health agencies and organizations offer resources such as:
- Counseling services
- Support groups
- Educational classes
- Phone helplines
- Lists of healthcare professionals
- Information on safe living or supervised facilities
These supports help improve both the caregiver’s and the patient’s quality of life.
Getting Ready for Your Visit
Steps You Can Take
Be organized before seeing a health care provider. Bring a written list that includes:
- Symptoms: Note all symptoms and when each one started.
- Medicines and Supplements: List every medication, vitamin, or supplement, along with the dosage.
- Questions: Write down any questions you want to discuss.
A friend or family member should come with you if possible. They can help share details you might forget and support you during the visit.
What the Doctor Will Want to Know
Doctors, especially specialists like neurologists and psychiatrists, usually ask about:
| Subject | Examples |
|---|---|
| Changes in memory or mood | Forgetfulness, mood swings, personality |
| Hallucinations | Seeing or hearing things that are not real |
| Medical and personal history | Strokes, depression, alcohol use, injuries |
Doctors will ask about any changes over time and whether you have a history of neurological or mental health issues.
