Parkinson's disease dementia and dementia with Lewy bodies... Are they the same thing?
I remember the first time I wondered about this question: Were there two different disorders with two different names, or one disorder that could be called both PDD and DLB? This question came about as I was reading through the medical history of a patient and noticed that in some places in his chart he had a diagnosis of PDD, and in other areas of his records, his diagnosis was listed as DLB.
In asking other professionals, I discovered that opinions varied about the answer to my question. I found that some physicians felt strongly that PDD and DLB were really variations of the same disorder, while others debated if the two conditions were significantly different from each other.
I sought further clarification by researching the diagnostic guidelines on these disorders, and found that currently agreed upon criteria is different for PDD as compared to DLB, although they're both considered to be a type of Lewy body dementia. In other words, PDD and DLB are classified as separate diagnoses. They have sets of symptoms that are similar to each other, yet they also have some specific differences from each other.
What's the Difference between Parkinson's Disease Dementia and Dementia with Lewy Bodies? - How are these conditions different from each other?
What's the Difference between Alzheimer's Disease and Lewy Body Dementia? - Lewy body dementia has some similarities to Alzheimer's disease, so how can you tell them apart?
10 Things to Know about Parkinson's Disease Dementia - Here are 10 quick facts about Parkinson's disease dementia.
A study was recently published in the Journal of the American Medical Association, outlining a trial of the antidepressant medication citalopram (brand names: Celexa and Cipramil) to treat agitation in dementia. Here are the results, which are both positive and negative:
- The participants who received citalopram showed a significant decrease in their agitation.
- Caregiver distress, which is increased by agitation, also significantly improved.
- However, those who received citalopram showed a decline in their cognitive ability over the 9-week course of the study, as well as an increase in cardiac issues associated with the medication.
So, while there was an improvement in the levels of agitation, which can be so distressing both for the person experiencing it and for those watching it, there are tradeoffs with the use of this medication, according to this study.
It's great to see the exploration of some different possibilities for the treatment of agitation, but this study does not throw me into the fan club yet. As caregivers, professionals, family members and friends, we collectively still need to improve in the use of non-drug approaches. I realize that not all agitation and distress can be solved without medications, and I've written about times and circumstances when medication is an appropriate, helpful and necessary treatment.
But- our mental approach to people with dementia, and our willingness to seek the cause of the behavior instead of just trying to make the behavior disappear, can make a world of difference.
To figure out what might be causing the behavior, review these possibilities and learn how you may be able to anticipate your patient or loved one's needs:
- Environmental / External Causes of Challenging Behaviors
- Physical Causes of Challenging Behaviors
- Psychological and Cognitive Causes of Challenging Behaviors
Understand that sometimes, difficult behaviors can be caused by loneliness and boredom:
- 8 Reasons Why Meaningful Activities Are Important for People with Dementia
- More than Bingo: Ideas for Meaningful Activities
- Recognizing Loneliness and Boredom as Problems for Those with Dementia
When are medications appropriate? Glad you asked. Here are a couple of references for you:
If you're a fan of sugary foods, you might want to stop reading this before you start. If, on the other hand, you're a fan of a healthy brain, proceed. (This, of course, leaves me in a quandary as I write, since I happen to be a fan of both sugar (unfortunately) and good brain functioning.)
In my quest to highlight ways to reduce our risk for Alzheimer's disease and other types of dementia, I came across several research studies on sugar and how it affects our brains. Some of these studies discuss the levels of glucose in our blood, and others simply look at how much sugar is consumed and how that amount affects our risk for dementia. Turns out, you may want to put down that candy bar you're enjoying.
We already know that there's a significant connection between type 2 diabetes (where sugar is less able to be processed) and dementia, but this set of research focuses on people without diabetes.
Just the Facts
Is Sugar Bad for Your Brain? (Please Tell Me "No!") - (Here's the research on sugar and how it affects our brains.)
Understanding the Connection Between Diabetes and Alzheimer's Disease - (50% of people with type 2 diabetes eventually develop Alzheimer's disease. Can effective treatment of diabetes reduce that chance? )
Why Is Alzheimer's Disease Called Type 3 Diabetes? (Learn why some researchers have given Alzheimer's disease the nickname of "Type 3 diabetes," as well as how it's similar to, and different from, type 2 diabetes.)
Let me begin with a disclaimer: I'm not a big coffee drinker, although I'm starting to wish I was! I tried to learn to drink it in college when I was staying up all night studying for an exam or finishing a paper. I tried again when I was in grad school, working and completing internships, all simultaneously. I'm sure I tried again after I was up all night with sleepless babies, though that's all a blur. (A nice blur, though.) I just don't love that bitter taste (yes, I heard that collective gasp of shock from all of the coffee lovers out there), although I do enjoy the smell of coffee.
Recently, however, I've begun to drink coffee mixed with hot chocolate, and I've decided it's quite tasty. Perhaps a little higher sugar content than pure coffee, but nonetheless, it keeps me warm, and I feel rather adult-like with my "coffee" in hand.
So why am I writing about coffee? Two reasons.
One: Research shows that caffeine may decrease the risk of Alzheimer's disease. Multiple studies have found a decreased risk of dementia in those who have consumed more caffeine, and some research particularly favors coffee over other sources of caffeine.
Two: Research also says caffeine can improve your memory, and that's a benefit most of us would enjoy.
Here Are the Facts
Does Caffeine Improve Your Memory? (Learn how caffeine can affect your memory, as well as how being an extrovert or introvert impacts the results of caffeine.)
Does Caffeine Increase or Decrease Your Risk of Alzheimer's Disease? (Okay, I just told you the answer to this question, but here's where research on dementia risk, brain size and caffeine is outlined.)
Study: Delay Alzheimer's by Drinking 3 Cups of Coffee a Day (A study found that people who drank about 3 cups of coffee a day and had mild cognitive impairment were less likely to develop Alzheimer's disease.)
Go Nuts! Walnuts, Coffee, Olive Oil + Wine = Improved Memory (Here's some research I published earlier on how these types of food impacts memory.)
Time now to enjoy my hot chocolate-coffee drink!
It seems as if there's always a supplement being hyped as being able to improve your memory or increase your energy. One that's frequently being talked about lately is fish oil and its purported benefits on brain health. If you're wondering if there's any truth to the claim that omega 3 fatty acids (found in certain types of fish including salmon, sardines and tuna, as well as walnuts and soybeans) are good for your brain, read on.
I reviewed the research published on this topic, and here's what I found. Several studies have shown improvements in memory, brain size and brain health as being correlated with higher levels of omega 3 fatty acids in the participants' bodies and/or the amounts of fish in their diets.
Conclusion? This is one claim that might not be so fishy after all.
Does Eating Fish Reduce the Risk of Alzheimer's Disease? (Learn more about fish, omega 3 fatty acids and reducing the risk of dementia.)
Your Brain: Does Size Really Matter? (Does a bigger brain mean a better memory?)
Reducing the Risk of Alzheimer's Disease through Physical Exercise (Here are the facts about exercise and its benefits for your brain.)
Want to decrease your chance of experiencing the forgetfulness and confusion that comes from Alzheimer's disease? According to several research studies, one way to do this is by increasing your education.
The theory behind these findings is that increased education boosts your cognitive reserve. Think of cognitive reserve as over-training for a race; for example, running 5 miles in practice so that you can run the 3 mile race with ease and without fatigue. Even if you have a cold on the day of the race, you may still be able to run 3 miles well because of your training.
It seems to be similar with our brains. If we stretch them and strengthen them through higher levels of education (and other studies show similar benefits from games, reading and other mental activities), they will be more able to compensate if they develop some of the physical abnormalities that may come with early dementia. Research has shown that people with higher education often continue to function well cognitively despite some of the changes associated with early Alzheimer's disease such as beta amyloid protein build up in the brain, while those with lower education levels show cognitive deficits with the same amount of protein deposits.
So, you may want to consider taking a class online or at your local school. It may enrich your life, increase your knowledge, and give you a boost in the future as well.
How Does Education Level Affect Your Risk of Dementia? (Here's the full article, including the related research studies.)
Are There Any Benefits from Crossword Puzzles? (We often hear of people doing crossword puzzles to stay mentally active, but do they really make a difference for our brain's functioning, or are they just a great way to pass the time?)
Mental Exercise: 12 Ways to Stretch Your Brain (Not sure where to start? Try one of these 12 ways to exercise your brain.)
It's almost the end of January. Did your New Year's resolution include losing weight? How's it going?
Many include weight loss on their "Goals for the New Year" list. Now, before you think this will be yet another article cautioning against putting on a few extra pounds and chastising you for losing sight of those resolutions you made, well, you're only partially correct.
Of course, we do know that extra weight has multiple health risks, and that closely related to losing that extra weight is the challenge of maintaining a physically active life. But how does extra weight affect the health of your brain?
In short, being overweight or obese in our middle years of life doesn't help our brains. Research has shown that extra pounds (or kilograms, depending on where you live) increase our risk of developing dementia. Being overweight has also been associated with a decreased brain volume (or size).
One interesting study, however, did find that for people in the later years of life, carrying a few extra pounds actually showed a protective effect against dementia- the older adults in that study who were a little overweight were less likely to develop dementia. In other words, wait until you're over 65 to gain a few pounds.
Does Being Overweight Increase Your Risk of Alzheimer's Disease? (This article includes the studies referenced above and provides more information on the association between dementia and weight.)
How Does Physical Exercise Reduce Your Dementia Risk? (Need motivation to exercise? This may help.)
The Connection between Type 2 Diabetes and Alzheimer's Disease (People with obesity have a higher risk for type 2 diabetes, and those with type 2 diabetes have a significantly higher chance of developing dementia.)
Back in the day, the fear of people falling or wandering was so significant that those with dementia were often tied into their chairs. The goal was to provide safety at all costs. Even worse, sometimes those restraints were for the sake of convenience. Fortunately, things have changed. As restraints were studied, researchers found that in general, more injuries- not less- and more serious ones, occurred when people were restrained.
In today's world, restraints are used infrequently and many facilities have a restraint-free policy. This is great, but now we've exchanged restraints for many alarms. Bed alarms, chair alarms, door alarms... so much noise. These alarms are a thousand times better than the use of any restraints. They allow freedom of movement, and summon help when it's needed.
However, whether the alarms are in use at a nursing home or in someone's own home, let's be intentional with our response to those alarms. Let's attempt to determine why the person was trying to get up and what he really needs, instead of just saying, "Let's sit down, Mr. Jones. We don't want you to fall." Let's walk with Mr. Jones and work on figuring out if he's bored, hungry, needs the bathroom or his legs need stretching. Let's assess if he's in pain or feeling depressed. Let's track whether this happens each day at the same time, and see if we can figure out how to proactively meet Mr. Jones' needs.
That is, after all, what we would want if we were in his shoes, isn't it?
The Use of Restraints for People with Dementia- Learn about today's restraints (for example, how pushing a person in a wheelchair up to a table is a restraint) and what you can do instead to increase the safety for the person with dementia.
Wandering in Dementia: Tips to Prevent It- Here are some practical ideas on how meet the person's needs and reduce the chances of wandering.
Causes of Falls in People with Dementia- Understanding why people fall can help reduce and prevent falls. And, when hip fractures are so detrimental to health and quality of life (see The Dangers of Hip Fractures in Dementia), prevention is critically important.
Detecting Depression in the Midst of Alzheimer's Disease- Recognizing and then treating depression in dementia is one way to clearly improve the quality of life for someone living with dementia.
Recognizing Loneliness and Boredom as Problems for People with Dementia- Ever thought what it might be like to have dementia? Some of the challenging behaviors people with Alzheimer's and other dementias exhibit can be connected to loneliness and boredom.
As Alzheimer's disease and other types of dementia progress, abstract thought processes become more difficult. One area we see this is in the ability to interpret proverbs. For example, someone with dementia might not be able to understand or explain what this proverb really means: "While the cat's away, the mice will play. " If questioned, they might respond that if the cat is out of the room, the mouse will play more- a very concrete understanding of what was stated, instead of an understanding of the intended meaning of the phrase.
This decline in ability to use abstract reasoning can greatly impact the person with dementia- it can lead to greater confusion, anxiety and communication difficulties. So- the next time you speak with someone with an intellectual disability such as dementia, consider how and what you're saying. You may want to skip the indirect or potentially confusing phrases, slang words and proverbs, and simply communicate with clear words.
One last thought for the day: As you use care with your words, don't forget that your non-verbals often communicate much more than your words. A little respect and a smile go a long way for all of us, dementia or not.
Bbbbrrrrrr... it's cold outside. (At least it is by me.) And depending on where you live, there's a ton of snow out there, too!
Winter weather, like what some of us are experiencing right now, can complicate anyone's life. But in the case of someone with Alzheimer's or another dementia, these type of temperatures and snow can not only complicate life- they can endanger life.
Take a moment to review these thoughts on safety, and feel free to add to them by commenting below. Stay safe and warm!