LEWY BODY DEMENTIA Hena Jawaid PGYIII Also known

LEWY BODY DEMENTIA Hena Jawaid PGY-III

Also known as …. 2 Cortical lewy body disease Lewy body variant of Alzheimer’s disease Diffuse lewy body disease senile dementia of Lewy type LBD - hena jawaid

History Of Disease 3 Frederic Lewy (1885– 1950) was first to discover the abnormal protein deposits ("Lewy body inclusions") in the mid 1900 s after the discovery of alpha-synuclein staining that highlighted Lewy bodies in the cortex of post mortem brains of a subset of dementia patients LBD - hena jawaid

History (cont. ) 4 Attention was drawn to DLB following the 2008 death of actress Estelle Getty, who had previously been diagnosed with both Parkinson's and Alzheimer's diseases before her true condition was discovered. Fellow Golden Girls cast members noted, years earlier, Getty had severe trouble remembering her lines during the filming of the show. LBD - hena jawaid

Anatomy 5 Presence of lewy body in cerebral cortex , also seen in Substantia nigra. The key protein is Alpha subnuclein (proteinicous cytoplasmic inclusions and Ubiquitin (regulatory protein that directs proteins to recycling). LBD - hena jawaid

Anatomy (Cont. ) 6 Neocortex – decreased choline transferase Hippocampal atrophy Severe nigrostriatal dopaminergic degeneration occurs in DLB, but not in Alzheimer's disease or most other dementia subtypes* Resource – Mc. Keith I et al, Lancet Neurol. 2007 Apr. Sensitivity and specificity of dopamine transporter imaging with 123 I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. LBD - hena jawaid

Anatomy (Recent Evidence) 7 Because unmodified alpha-synuclein is degraded by the proteasome in a ubiquitin-independent manner, these data suggest that accumulation of modified alpha-synuclein is a disease-specific event leading to aberrant ubiquitination. Resource- Tofaris GK et al, J Biol Chem. 2003 Nov LBD - hena jawaid

Clinical Features - key 8 Progressive cognitive decline – roads, maps and stairs Cognitive fluctuations Formed and defined visual hallucination Motor features of Parkinsonism LBD - hena jawaid

Clinical Features - Supporting 9 Falls Syncope Adverse reaction to antipsychotics LBD - hena jawaid

Clinical Features - Rare 10 Cerebrovascular disease stroke LBD - hena jawaid

Difference 11 1. 2. 3. 4. 5. Alzheimer’s Plaques and tangles Memory loss Normal moves No sleep with association Hallucination in advance stages only 1. 2. 3. 4. 5. LBD - hena jawaid Lewy Body Alpha – synuclein Decreased attention Parkinsonism REM sleep behavior disorder is a risk factor Visual hallucination

12 NON-PHARMACOLOGICAL INTERVENTIONS LBD - hena jawaid

Ways To Manage LBD 13 Become informed. Learn as much as you can about LBD and how it is likely to affect your loved one specifically, given his or health history, age, and lifestyle. Create a routine. It may help people with Lewy Body Dementia to have predictable routines, especially around meal times and sleep times. Establish a night-time ritual. Try to establish bedtime rituals that are calming and away from the noise of television, meal cleanup, and active family members. Limit caffeine, discourage napping, and encourage exercise. LBD - hena jawaid

Ways To Manage LBD 14 Modify tasks. Break tasks into easier steps and focus on success, not failure. Walk together. Taking a walk with the patient with LBD is a winwin activity. Being outdoors and exercising is vital for the health and state of mind—of both of you. Strengthen senses Have a doctor evaluate each the patient’s five senses in order to identify and treat any abnormalities. Then ask about exercises to improve them. Make behavioral changes. To help minimize the risk of fallrelated injuries, you can help stabilize blood pressure. Help your loved one stay well hydrated, exercise, take in adequate sodium (salt), avoid prolonged bed rest, and stand up slowly. LBD - hena jawaid

15 PHARMACOLOGICAL INTERVENTIONS LBD - hena jawaid

Recent Evidences 16 There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in approximately 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors. Resource - Mc. Keith IG, Neurology. 2005 Dec 27; 65(12) Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. LBD - hena jawaid

Pharmacological Management 17 There is no cure for DLB. q Acetylcholinesterase inhibitors, inhibitors such as donepezil and rivastigmine, are primarily used to treat the cognitive symptoms of DLB, but they may also be of some benefit in reducing the psychiatric and motor symptoms. q Some individuals with DLB may benefit from the use of levodopa for their rigidity and loss of spontaneous movement. q Resource -www. ninds. nih. gov/disorders/dementiawithlewybodies. htm LBD - hena jawaid

References 18 www. helpguide. org/elder/lewy_body_disease. htm en. wikipedia. org/wiki/Dementia_with_Lewy_bo dies LBD - hena jawaid

19 THANK YOU LBD - hena jawaid