Dementia with Lewy Bodies (DLB) is a progressive degenerative disease or syndrome of the brain. It shares symptoms - and sometimes overlaps - with several diseases, especially with two common diseases of older adults, Alzheimer’s and Parkinson’s.

DLB is named after smooth round protein lumps, called Lewy bodies, that are found in the nerve cells of affected brains. Lewy bodies are often present in the nuclei (nerve cells) of brains afflicted with a variety of disorders. In DLB, the Lewy bodies are found throughout the outer layer of the brain (the cerebral cortex) and deep inside the midbrain or brainstem. These “abnormal protein structures” were first described in 1912 by Frederich Heinrich Lewy, M. D., a contemporary of Alois Alzheimer who first identified the more common form of dementia that bears his name.

What are the symptoms?

The dementia associated with Lewy body disease affects:

memory
language
the ability to judge distances
the ability to carry out simple actions
the ability to reason.

People with this form of dementia suffer hallucinations for example seeing a person or pet on a bed or a chair when nothing is there.

They may suffer from falls for no apparent reason, because their ability to judge distances and make movements and actions accurately is disrupted.

They may develop some Parkinson type symptoms such as slowness of movement, stiffness and tremor. In a few cases heart rate and blood pressure are affected.

The abilities of the affected person often fluctuate from hour to hour, and over weeks and months. This sometimes causes carers to think that the person is 'putting on' their confusion.

If the physician tries to treat patients with Lewy Body dementia with anti-psychotic medications to get rid of the hallucinations, the Lewy Body patient often will have severe side effects from the medication, even on very low dosages. If Lewy Body patients are given anti-psychotic medication, they are at three to four times greater risk of severe side effects or even death than other patients.

It is believed that DLB, as a defined disease process, accounts for as many as 20% of the seven million cases of dementia in the United States and for as much as one-third of dementing illness in elderly Americans. This makes DLB the second most common form of dementia after Alzheimer’s.

The cause of DLB is unknown and no specific risk factors are identified. Cases have appeared among families but there does not seem to be a strong tendency for inheriting the disease. Genetic research may reveal more information.

I have taken care of several people with DLB. You can tell what the diagnosis is by their stooped, shuffling gait. The hallucinations are severe in some cases, and as mentioned above, the medications that will help with the hallucinations may also harm. The hallucinations can make the person violent and agitated.

About 2 years ago I was called at 2 a.m. because a staff member had been taken to the floor by a resident suffering from DLB. He saw her as his ex- wife who had stolen all his money. The staff member was terrified, rightly so, and by the time I had made it to the facility the resident had quietly went to his room and was sleeping. This man had been a gentleman all his life. He would be devastated to know the terror he had caused. He couldn't help it. He has since passed.

There are so many diseases that cause dementia. They seem unreal, and in this age, I wonder why we can't find a cure. The people suffering from these illnesses are heros, through them we are learning, and someday, I believe we will see an end to all of the suffering.

So many of my stream friends have asked how the new job is going. It's hard to believe it almost been a month already. Things are starting to be at least tolerable.

The new facility where I work is an assisted living facility. Each resident has their own apartment. The building is sent up like a motel. They can lock their doors and come and go as they please. There are a few residents there that are beyond the care we should be providing. This worries me as I really don't feel they are within the guidelines, the "rules," of an assisted living facility. This may or may not put my nursing license in jeopardy. I have to be very careful about what I do and chart as I know the regulations and try to remain within the boundaries.

The residents have started to trust me and view me as a kind, caring person. It breaks my heart when I do special things for them and they reply, "Why are you so nice to me?" The attitudes of some of the staff is, to say the least, unacceptable. There is no accountability or follow-up there. It is the total opposite of what I had been used to for the last 17 years.

I have brought a few of my concerns to management. (Seems weird I used to get all those suggestions, now I'm making them.) The reply is usually, "we like a more casual setting for our staff." Alrighty then.....

I will continue on. I will try to make small subtle changes to slowly get things on track. I have no desire to have relationships with these people(the staff) beyond a professional level. They all pretty much disgust me.

There are things I like. The residents are delightful. There are a few people with mild to moderate dementia that I feel I can help. There are several married couples there, they are so sweet. To see people that have been married for over 60 years is unbelievable to me. The hours are good and my phone never rings after I leave there I just put my time in and come home. I am confident I will find my place there it will just take time.

It seems I've offended someone with this post so I have deleted it.

It was meant to be humorous, sorry for any hurt feelings it may have caused.

Joy

Pick's Disease is a progressively degenerative neurological disease similar to Alzheimer's Disease for which there is no known prevention, or cure. Pick's Disease affects the frontal and temporal lobes first, with earliest symptoms showing up as changes in personality and a decline in function at home as well as work. Pick's Disease is frequently first diagnosed as stress or depression and then as Alzheimer's disease. The treatment of Pick's disease is the same as for various stages of other dementias such as Alzheimer's. This accounts for so little information being available related specifically to the treatment of Pick's Disease.

Pick's Disease accounts for just five percent of all progressive dementias.

In some ways, Pick's disease is similar to Alzheimer's disease. However, Pick's disease tends to affect only certain areas of the brain, while Alzheimer's can affect any part.

Pick's disease is rare. It is more common in women than men. It may occur in people as young as 20, but usually begins between ages 40 and 60. The average age of onset is 54.

The disease can progress slowly. Over time, the tissues in two parts of the brain (the temporal and frontal lobes) shrink. This shrinking is called atrophy. Symptoms such as behavioral changes, speech difficulty, and impaired intellect occur gradually, but continue to get worse.

People with Pick's disease have abnormalities called Pick bodies and Pick cells inside nerve cells in the damaged areas of the brain. Pick bodies and Pick cells contain an abnormal form of a protein called tau. This protein is found in all nerve cells. But some people with Pick's disease have an abnormal amount or type of tau. The exact cause of these abnormalities is unknown.

Upon autopsy, patients are typically found to have atrophy of the frontal and temporal lobes of the brain. Patients with more severe behavioral symptoms are often found to have this damage focused in the frontal lobe.

When viewed under the microscope, some nerve cells in this area have characteristic abnormalities (inclusions called Pick bodies and swollen cells called Pick cells). These abnormalities are named for the neurologist Arnold Pick, who first identified them in 1892.

The marked atrophy of Pick's disease, a senile dementia, produces "knife-like" thinning of the gyri in frontal lobes and temporal lobes.




What are the signs and symptoms of Pick's Disease?

Because the frontal lobes affect behavior and emotional response, people with Pick's Disease will usually show signs of changes in personality before they manifest evidence of dementia. This may begin as impulsiveness or a lack of inhibition. While the progression of symptoms in Pick's Disease is fortunately slow, symptoms do worsen over time.

The following symptoms are typical of patients with Pick's Disease.

More severe symptoms will appear in later stages of the illness:

Behavioral changes

Impulsivity
Obsessive/compulsiveness (for example, overeating or only eating one type of food)
Drinking alcohol to excess (when this was not previously a problem)
Rudeness or impatience, leading to aggression
Poor judgment
Withdrawal or seclusion
Inability to function or interact in social situations
Inability to hold a job
Lack of attention to personal hygiene
Sexual exhibitionism or promiscuity

Emotional changes

Abrupt mood changes
Lack of warmth, concern, or empathy
Indifference to events or to one's environment
Easily distracted; difficulty maintaining a line of thought
Unaware of the changes in behavior
Decreased interest in activities of daily living
Language changes
Reduced quality of speech: shrinking vocabulary, difficulty finding a word
Difficulty speaking or understanding speech (aphasia)
Repeating words others say (echolalia)
Weak, uncoordinated speech sounds
Decreased ability to read or write
Complete loss of speech (mute)

Neurological/physical problems

Increased muscle rigidity or stiffness
Difficulty moving about
Lack of coordination
General weakness
Memory loss
Urinary incontinence

In my career I have taken care of only one person suffering from Pick's Disease. She displayed many of the symptoms listed above. When walking into the facility and taking a quick glance at the residents she would definitely stand out. Her make-up was very over done, bright blue eye shadow with bright red lipstick. She would wear 3 watches at a time, 15 rings, 10 necklaces. She liked men, even having romantic thoughts about her closest relatives, her doctors, and male staff. She would eat to the point of getting sick, and continue to eat. She had severe mood swings, and would say inappropriate things. When the frontal lobe the of brain is affected the personality will change showing disregard for social decorum or the feelings of others.

It is a devastating disease, with no cure. The behaviors are managed with medications. I found this resident to be delightful at most times. She reminded me of the truthfulness of a child, saying what was on her mind without knowing it may be the most inappropriate thing to say at the time. I know she would be mortified if she knew. She was, and still is a grand woman holding a masters degree in music and was a teacher for many years. She has a beautiful sense of humor and will chuckle at herself, knowing at times, she had shocked and amazed the people around her. She is an angel.

Life deals some dreadful hands. Embrace each day.

Keep away from people who try to belittle your ambitions. Small people always do that, but the really great make you feel that you, too, can become great."

-Mark Twain-