Introduction tests that can be taken out to

Introduction

Alzheimer’s
and Dementia with Lewy bodies (DLB) are two separate but similar conditions. Alzheimer’s damages
the hippocampus, which alters the brain’s ability to store memories which
causes memory loss, the symptom the disease is most commonly known for.  Dementia with Lewy bodies, on the other hand,
affects different functions of the brain, specifically the ability to reason and
solve problems.
Although there are tests that can be taken out to more conclusively determine if
a patient has these conditions, in general, both Alzheimer’s and DLB are
diagnosed through observation and tracking the progression of a patients behaviour
and symptoms.

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Dementia with Lewy bodies (DLB)

Dementia with Lewy bodies (DLB) is a progressive type
of dementia that can go from confusion and different behaviour/ways
of thinking to a complete decline
in thinking, responding normal behaviour, reasoning
and eventually
normal, independent function in everyday situations. DLB is detected by the abnormal masses of proteins
building up into deposits known as Lewy
bodies. This protein, however, is also associated with Parkinson’s disease and Parkinson’s
dementia disease, which can cause difficulties when diagnosing a patient.
People who have Lewy bodies in
their brains often also have the plaques and tangles associated with
Alzheimer’s disease.  Plaques and tangles can cause
major tissue loss and the death of cells in the brain of an Alzheimer’s patient. Plaques are unusual clumps of “sticky” proteins called
beta-amyloid that build up around and in-between nerve cells.

Symptoms of DLB

DLB patients often
have a common symptom of becoming randomly confused about their
location or actions and they may not understand what
they are doing and/or their surroundings during the day. They
can possibly become panicked or frightened easily and be more alert than
usual. Another main symptom of DLB is a change in the way someone thinks, talks
or acts. Like most DLB symptoms, this change is not always easy to pick up
on at first however it becomes more noticeable as the
condition becomes more severe. This pattern is also seen in
hallucinations patients are known to experience, they often start out a small
figments of the imagination, such as animals, and progressively worsen into
complete delusions with the patients believing that certain aspects of their
lives are completely different to reality. The disease also has mutual symptoms
with Parkinson’s and Alzheimer’s disease. Someone suffering from DLB may experience
a different or unusual posture, stiff or sore muscles and problems staying
stable and balancing, much like many Parkinson’s patients. Alzheimer’s most well-known
symptom is memory loss and this symptom is also present in DLB patients. Though
not often as severe as that of Alzheimer’s patients, sufferers can experience
memory loss as both diseases damage the hippocampus, the part of the brain that
stores information as memories. This can also lead to patients being unable to understand
viual information.

Diagnosis

Similar to other
types of dementia there
is not one completely accurate, individual test that can determine the presence
of DLB nor a definitive cure. Currently, DLB is a clinical diagnosis, meaning it
is based on the doctor’s judgement and what condition they believe the patient
to have the traits/symptoms of. The only way to conclusively and definitively
diagnose DLB is after a patient has died through an examination of the body.
Which is only partially useful as obviously doctors need to be able to diagnose
the disease while the patient is alive so they can begin treatment

Many scientists and
doctors believe that DLB and Parkinson’s disease dementia (PDD) branch off from
the same problems but develop separately, due to their similarities. However, it
is important that they are diagnosed separately for now so patients can follow
the most efficient path of treatment until more advanced cures and diagnosis
methods are developed. Doctors will diagnose patients with DLB when the
symptoms are clearly present and have developed about a year or less after the
movement function symptoms shared with Parkinson’s, as those symptoms are
usually present before the rest.

Scientists haven’t found any
clear causes of DLB.Nearly all patients diagnosed lack genetic links to the
disease and have an average lifestyle and average health. The patients that
have been recorded have different genders, lifestyles, ethnicities and standards
of living that share little to no correlation, however the disease is more
common in those that are middle-aged and above.

 

Prognosis

DLB has no cure and there
are no existing treatments that can slow down or prevent the brain cell damage
caused by DLB; it is a progressive, life shortening disease that causes irreparable
damage that cannot yet be stopped.  Currently,
strategies focus on developing and using medicines to help alleviate/manage
symptoms.

 

 

Alzheimer’s disease

Alzheimer’s
disease is the most common cause of dementia. The word dementia describes a group
of symptoms that can include memory loss and difficulties with thinking,
problem-solving or language, however many people just associate it with the
memory loss. These symptoms occur when the brain is damaged by certain
diseases, including Alzheimer’s disease. proteins build up in the brain to form
structures called ‘plaques’ and ‘tangles’. This leads to the loss of
connections between nerve cells, and eventually to the death of nerve cells and
loss of brain tissue. People with Alzheimer’s also have a shortage of some
important chemicals in their brain. These chemical messengers help to transmit
signals around the brain. When there is a shortage of them, the signals are not
transmitted as effectively, leading to the brain to not function how it should.
As discussed below, current treatments for Alzheimer’s disease can help create
more of these important chemical messengers in the brain, which can help the
brain to function how it should and help and even possibly stop some of the
symptoms.

Symptoms

The symptoms of Alzheimer’s
disease progress slowly over several years. Sometimes these symptoms are
confused with other conditions and may initially be put down to old age.

The rate at which the symptoms
progress is different for each individual and it’s not possible to predict
exactly how quickly it will get worse.

In some cases, infections,
medications, strokes or delirium can be responsible for symptoms getting
worse

Generally,
the symptoms of Alzheimer’s disease are divided into three main stages.

Early symptoms

In
the early stages, the main symptom of Alzheimer’s disease is memory
lapses. For example, someone with early Alzheimer’s disease may sometimes
forget the names of places and objects, or have trouble thinking of the right
word, which many people with healthy brains sometimes do however it becomes
considerably more noticeable when their memory begins to completely deteriorate.
They will start to often repeat themselves as well as begin to find it hard to
make decisions and avoid trying new things.

There
are often signs of mood changes, such as increasing anxiety or agitation,
or periods of confusion, much like DLB.

Middle-stage symptoms

As
Alzheimer’s disease develops, memory problems will get worse. Someone with the
condition may find it increasingly difficult to remember the names of
people they know and may struggle to recognise their family and friends.

Other
symptoms may also develop, such as:

increasing confusion and disorientation –
for example, getting lost, or wandering and not knowing what time of day
it is
obsessive, repetitive or impulsive behaviour
delusions (believing things that are untrue)
or feeling paranoid and suspicious about carers or family members
problems
with speech or language (aphasia)
disturbed sleep
changes in mood, such as frequent mood swings, depression and feeling increasingly anxious, frustrated or agitated
difficulty performing spatial tasks, such as judging distances
hallucinations

By
this stage, someone with Alzheimer’s disease usually needs support to help them
with their everyday living. For example, they may need help eating,
washing, getting dressed and using the toilet.

Late
Symptoms

In
the later stages of Alzheimer’s disease, the symptoms become increasingly
severe and distressing for the person with the condition, as well as their
carers, friends and family.

Hallucinations
and delusions may come and go over the course of the illness, but can
get worse as the condition progresses. Sometimes people with Alzheimer’s
disease can be violent, demanding and suspicious of those around them.

A
number of other symptoms may also develop as Alzheimer’s disease progresses,
such as:

o  
difficulty
eating and swallowing (dysphagia)

o  
difficulty changing position or moving around
without assistance

o  
considerable weight loss – although some
people eat too much and put on weight

o  
unintentional
passing of urine (urinary incontinence) or
stools (bowel
incontinence)

o   gradual loss of speech

o   significant problems with short- and long-term
memory

o   In the severe stages of Alzheimer’s disease, people
may need full-time care and assistance with eating, moving and using the
toilet.

 

Causes

The exact cause is unknown but we
do know that ‘plaques’ and ‘tangles’ form in the brain due to two proteins
called amyloid (plaques) and tau (tangles).

Amyloid
is a naturally occurring protein which for a reason that is not yet
understood begins to malfunction, creating beta amyloid which is
toxic to the brain cells. Plaques form consisting of dead cells and
amyloid protein.
Tau
protein naturally occurs in the brain and helps brain cells communicate
with each other but for a reason that is not yet understood it can
become abnormal and “clump together” leading to death of the brain cells
affected.

A
number of factors are thought to increase your risk of developing the
condition. These include:

o   increasing age

o   a family history of the condition

o   previous severe
head injuries

o   lifestyle factors and conditions associated
with cardiovascular
disease

 

 

Diagnosis

There is no single test for Alzheimer’s disease. A
GP will first need to rule out conditions that can have similar symptoms, such
as infections, vitamin and thyroid deficiencies (from a blood test), depression
and side effects of medication.

The doctor will also talk to the person, and where
possible someone who knows them well, about their medical history and how their
symptoms are affecting their life. The GP or a practice nurse may ask the
person to do some tests of mental abilities.

The GP may feel able to make a diagnosis of
Alzheimer’s at this stage. If not, they will generally refer the person to a
specialist. This could be an old-age psychiatrist (who specialises in the
mental health of older people) often based in a memory service. Or it might be
a geriatrician (who specialises in the physical health of older people), a
neurologist (who specialises in conditions of the brain and nervous system) or
a general adult psychiatrist (who specialises in mental health in adults) in a
hospital.

The specialist will assess the person’s symptoms,
and how they developed, in more detail. In Alzheimer’s disease there will
usually have been a gradual worsening of memory over several months. A family
member may be more aware of these changes than the person with suspected
Alzheimer’s is themselves.

The person’s memory, thinking and other mental
abilities will also be assessed further with a pen-and-paper test. When someone
with Alzheimer’s is tested, they will often forget things quite quickly. They
will often not be able to recall them a few minutes later even when prompted.

The person may undergo a brain scan, which can show
whether certain changes have taken place in the brain. There are a number of
different types of brain scan. The most widely used are CT (computerised
tomography) and MRI (magnetic resonance imaging). A brain scan may rule out
certain conditions such as stroke, tumour or a build-up of fluid inside the
brain. These can have symptoms similar to those of Alzheimer’s. It may also
clarify the type of dementia. In a person with early Alzheimer’s disease a
brain scan may show that the hippocampus and surrounding brain tissue have
shrunk.

Prognosis

Currently, there is no cure for Alzheimer’s,
however, drug and non-drug treatments may help with both cognitive and
behavioral symptoms.

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