What Are the First Signs of Lewy Body Dementia?

Lewy body dementia is a complex and progressive disorder of the nervous system with unique challenges for patients, caregivers, and medical professionals. Recognition of early signs is imperative to achieve timely diagnosis and appropriate care. Below we provide an in-depth overview of the initial symptoms of Lewy body dementia, while also exploring the stages of Lewy body dementia to help families prepare for the progression of this condition.

Understanding Lewy Body Dementia: An Overview

Lewy body dementia is caused by the abnormal buildup of proteins called alpha-synuclein in the brain. These protein clusters, known as Lewy bodies, disrupt the brain's normal functioning, affecting movement, cognition, and behavior. LBD is the second most common form of progressive dementia after Alzheimer's disease, highlighting the importance of early detection.

Early Cognitive Symptoms of Lewy Body Dementia

1. Fluctuating Cognitive Abilities

One of the most common early indicators of Lewy body dementia is fluctuating cognitive ability. This is not the case in Alzheimer's, where cognitive impairment tends to be constant. Patients with LBD will sometimes have moments of clarity, then confusion or disorientation, lasting anywhere from minutes to hours, and unpredictable at best.

2. Poor problem-solving and planning

The early stages of LBD are often characterized by problems in executive functioning. Patients may fail to manage tasks, unable to comply with complex instructions, or solve problems they can still handle. All this might make routine chores difficult.

Visual and Sensory Hallucinations

3. Visual Hallucinations

Visual hallucinations are among the earliest and most characteristic symptoms of Lewy body dementia. Patients may describe seeing people, animals, or objects that are not there. Unlike hallucinations caused by psychiatric conditions, these visual distortions are often vivid and detailed.

4. Other Sensory Disturbances

Apart from visual hallucinations, the patient may also develop auditory or tactile hallucinations. For example, a few patients experience sensations like being touched by someone when no one is present, which further intensifies feelings of anxiety or paranoia.

Movement-Related Symptoms

5. Parkinsonian Features

Lewy body dementia shares many features with Parkinson's disease, especially in the early stages. Tremors, muscle stiffness, shuffling gait, and slowed movement (bradykinesia) are common early symptoms. These symptoms may initially be mistaken for typical Parkinson's disease.

6. Frequent Falls and Poor Balance

As LBD advances, problems with coordination lead to falls and loss of balance. Such symptoms often occur before any cognitive decline is recognized, thus serving as a significant early sign of the disease.

Sleep Disturbances

7. REM Sleep Behavior Disorder (RBD)

One of the earliest manifestations of LBD is REM sleep behavior disorder. This condition causes patients to enact their dreams, at times resulting in shouting, kicking, or falling out of bed. Often caregivers will note these behaviors long before cognitive or motor impairment begins to manifest.

8. Daytime Somnolence

Profound daytime fatigue also occurs during the early stages of Lewy body dementia. Long hours of sleep fail to refresh the patients, and they sleep excessively during the day.

Mood and Behavioral Changes

9. Anxiety and Depression

Mood disorders, for instance, anxiety and depression are common early symptoms of Lewy body dementia. Such changes might be associated with chemical imbalances in the brain by Lewy bodies, affecting the quality of life considerably in the patient.

10. Apathy and Social Withdrawal

Another early symptom of LBD is apathy. Individuals become disinterested in most activities that they previously enjoyed. Often, they withdraw from relationships and may seem to feel flat or unresponsive in their environment.

Dysfunction of the Autonomic Nervous System

11. Orthostatic Hypotension

Some patients experience blood pressure which drops upon standing (this can lead to dizziness and increased risk for falls).

12. Urinary and Digestive Problems

Early symptoms include urinating too often, constipation, or other gastrointestinal disorders. Often, people pay less attention to these symptoms but might be the first indicators of LBD.

Stages of Lewy Body Dementia

Understanding the Lewy body dementia stages is essential for families and caregivers to anticipate the progression of symptoms. While every patient is unique, LBD generally progresses through the following phases:

1. Early Stage

• Mild cognitive changes, such as difficulty with problem-solving.
• Hallucinations or sleep disturbances.
• Mild motor symptoms similar to Parkinson's disease.

2. Middle Stage

• Severe cognitive decline, such as memory loss and confusion.
• Frequent and intense hallucinations.
• Motor symptoms worsening, including stiffness and loss of balance.

3. Late Stage

• Severe cognitive decline, making it difficult to communicate and perform daily activities.
• Increased physical disability, leading to immobility.
• Complications, such as infections or swallowing difficulties, which may necessitate palliative care.

When to See a Doctor

If you or a loved one has any of the early symptoms of Lewy body dementia, you should see a healthcare provider. Early diagnosis can make symptom management easier and gives families the tools to help navigate the challenges of LBD.