Level 3 Health and Social Care Unit 365dementia

Having an immediate family member who has this form of dementia may increase your risk of getting it.

The person may become confused when handling money and undergo personality changes, appearing to no longer care about those around them. Swings are common and the person may become tearful for no apparent reason, or become convinced that someone is trying to harm them.In advanced cases people may also adopt unsettling behaviour like getting up in the middle of the night or wander off and become lost. Some people lose their inhibitions and sense of what is acceptable behaviour, undress in public or make inappropriate sexual advances. The person may become incontinent, have difficulty eating and drinking and may become completely dependent on others.2. Symptoms usually develop suddenly and progress in a step like way where a sudden worsening is followed by a period of stabilisation. Common symptoms include poor concentration and difficulties with communication. memory loss may also lead to confusion.As vascular dementia does not affect all of the brain, the individual may be able to retain more of their abilities and memory loss may not appear until later in the progression of the disease. This means that the individual may be more aware of their deteriorating health and may therefore be more at risk of depression.3. Dementia with Lewy Bodies is a

Parkinson disease (PD) is one of the most common neurologic disorders. and it affects approximately 1% of individuals older than 60 years old. Parkinson’s disease is a condition that progresses slowly by treatment. In addition, loss of pigmented dopaminergic neurons of the substantianigra pars compacta and the presence of Lewy bodies and Lewyneurites are the two major neuropathologic findings in Parkinson disease (Hauser, 2016).

Dementia with Lewy bodies (DLB) is a type of dementia that shares symptoms with both Alzheimer 's disease and Parkinson 's disease. It may account for around 10 per cent of all cases of dementia (Alzheimer’s Society, 2016). Lewy refers to the inflammation or neuro-inflammation of the brain (Surendranathan et al, 2015). Both Parkinson 's disease and dementia with Lewy bodies are age-related diseases, although onset before age 65 years is not uncommon and both diseases are more common in men than in women (Walker et al, 2015).

Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimers disease dementia.

More specifically the hippocampus. Alzheimer’s dementia is most affected by shrinkage of the hippocampus, which makes it difficult to remember and store new and current events. Lewy body dementia research shows less shrinkage of the hippocampus. This suggest why there are different symptoms associated with each dementia. Shrinkage of the brain is caused by injury or death of brain cells. The white matter of the brain is also affected. Damage to white brain matter can disconnect the certain communications throughout the brain in turn affecting speech, movement, and

Other type of dementia can be coupled with a rare hereditary disorder known as CADASIL which stands for cerebral autosomal dominant ateriopathy with subcortical infarct and leukoencephalopathy. This disorder is linked to abnormalities of a specific gene, Notch3 located on chromosome 19. The first symptoms arise at the age of 20 or 35 or 40 and the individuals often die at the age of 65. Researchers are still working to find out the exact cause of CADASIL. Other causes of vascular dementia include vasculitis, hypertension and lesions caused due to brain hemorrhage. An autoimmune disease, lupus erythematosus and inflammatory disease temporal arteritis can also damage blood vessels resulting in dementia.

Dementia with Lewy bodies (DLB), when cognitive symptoms appear within a year of movement problems, is a complex and challenging neurodegenerative disorder. (Pervin, Edwards & Lippa, 2016). It is complex because the DLB pathology and its impact on certain brain regions are unclear. The pathology includes Lewy bodies, senile plaques and neurofibrillary tangles. It is challenging because its many core features make it difficult for individuals to perform activities of daily living. The core clinical features comprise of declining and fluctuating cognition, behavioural and psychotic behaviours and spontaneous signs of parkinsonism.

As a medical practitioner, I was always fascinated by the complexities of the human nervous system. A few years later, during my neurology residency training, I developed special interests in the field of neurodegenerative disorders and dementias. These are largely non-curable disorders

Dementia is not a disease but rather a group of symptoms caused by disorders that affect the brain (National Institute of Neurological Disorders and Stroke, n. d). The hallmark of dementia, memory impairment, is accompanied by deficits in language, motor function, recognition, or executive function (Stahl, 2013). The most common forms of dementia are caused by Alzheimer’s disease (AD), vascular dementia, Lewy body dementia, and frontotemporal lobar degeneration (Prince et al., 2013). The risk of dementia increases with age. Dementia is rare below the age of sixty but affects about 17% of those between 80 and 85 years of age, 33% of those between 85 and 90 years old, and 50% of those over 90 years of age (Tom et al., 2015). As the

Some common symptoms that come along with LBD include: “impaired thinking, memory, ability to understand visual information, tremors, stiffness, slowness, difficulty walking, visual hallucinations, sleep disorders such as acting out one’s dreams, depression, apathy, anxiety, agitation, delusions, paranoia, temperate regulation, blood pressure control, and bladder and bowel functions” ("10 Things You Should Know about LBD | Lewy Body Dementia Association"). These numerous symptoms hinder the person’s life in every way possible making it very difficult to care for someone with all these symptoms.

Parkinson disease is known as a progressive disorder that affects the nervous system. Some of the main symptoms of the disorder include tremor, muscular rigidity and slow imprecise movement. On the other hand Alzheimer 's disease is the most common cause of dementia. The disorder includes memory loss along with difficulties with thinking, problem-solving or language.

Rongve notes, “…there are currently no data suggesting that the course or treatment of dementia with Lewy bodies differs from that of PDD, and thus the distinction between dementia with Lewy bodies and PDD is not of major clinical importance”. This has to do with the fact that Parkinson’s disease, Parkinson’s disease dementia, and dementia with Lewy bodies all have pathology that involves neuronal loss and inclusion bodies comprised of alpha-synuclein, also known as Lewy bodies (Rongve). Since the disease state of the patient has very similar and overlapping pathologies, the treatment of these diseases will also be comparable and overlap. It has been shown that physical exercise can increase blood flow to the brain and aid in improved cognitive function, along with helping in motor function, balance and muscle strength (Aarsland). The increase in cognition may be due to the increased blood flow to the cerebrum, resulting in increased function of the neurons, and aid in neurogenesis, which will also have an effect on the cerebral and cerebellar tissues involved in motor function, balance, and muscle tone. One of the causes of PD is the loss of dopaminergic neurons in the substantia nigra, so patients are given cholinesterase inhibitors such as rivastigmine (Poewe). With the destruction of dopaminergic neurons in the substantia nigra, the goal is to extend the action of

“LBD is an umbrella term for two related diagnoses. LBD refers to both Parkinson’s disease dementia and dementia with Lewy bodies.” (Lewy Body Dementia Association 2015). According to Perry and Perry R.H (1995) Lewy body dementia is related to a disturbance in cholinergic transmission. Neocortical cholinergic deficits in this disorder are more extensive than in Alzheimers disease and are associated with symptoms that are commonly related to delirium, such as visual

One of the pathologic features that we are sure of is that in Parkinson’s disease there is a loss of dopaminergic pigmented neurons in the substantia nigra and dopaminergic deficiency in the putamen portion of the striatum. In Parkinson’s disease there is a loss of dopamine in other areas of the brain, too. There is also austere degeneration of basal ganglia and those dopaminergic pathways to the basal ganglia. This degeneration leads to decreased activity of the direct motor pathways, which normally facilitate movement, and increased activity of the indirect motor loop which normally inhibits movement. Another words, we have two different pathways that have deteriorated and are amplifying our inability to move. In the presence of Parkinson’s disease Lewy bodies are also present and are markers for neuronal degeneration (McCance,