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What’s the Difference Between Alzheimer’s and Lewy Body Dementia?

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Updated June 27, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Alzheimer’s disease and Lewy body dementia (LBD) are both types of dementia. They have several similarities, but there are also some clear differences between the two diseases.

Prevalence:

LBD: Lewy body dementia is the second most common type of dementia, with an estimated 1.3 million Americans diagnosed.

Alzheimer’s: Alzheimer's disease is the most prevalent type of dementia. There are about 5.4 million Americans with Alzheimer’s disease.
 

Cognition:

LBD: Symptoms and memory can vary significantly in LBD, such that on one day your relative might not recognize you and the next day, she can recall the names of each of her grandchildren.

Alzheimer’s: While cognition can vary somewhat in Alzheimer’s, typically the person’s ability to think and use his memory gradually declines over time. In Alzheimer's symptoms, there is not usually a big variance from one day to the next.
 

Walking and Physical Movement:

LBD: Often, one of the early symptoms of LBD is difficulty walking, a decrease in balance and ability to control physical movements. These symptoms are similar to Parkinson’s disease. Frequent falling is also common early in LBD.

Alzheimer’s: Physical deterioration usually does not occur in Alzheimer’s until the disease has significantly progressed, unless the individual has other diseases or illnesses.
 

Facial Expressions:

LBD: Some people who have LBD display a flat affect, where their faces show very little emotion. This is another symptom that may present early in the disease and overlaps with Parkinson’s.

Alzheimer’s: While facial expressions often decrease as the disease progresses, this often doesn’t develop until the middle to later stages of Alzheimer’s.
 

Visual Hallucinations:

LBD: Visual hallucinations, where people see things that aren’t actually there, are quite common in LBD.

Alzheimer’s: Hallucinations do occur in Alzheimer’s, but are generally not as prevalent as in LBD.
 

REM Sleep Behavior Disorder:

LBD: People with LBD sometimes experience REM sleep behavior disorder, a dysfunction where they physically act out the situations in their dreams.

Alzheimer’s: REM sleep behavior disorder is not typically present in Alzheimer’s.
 

Significant Sensitivity to Antipsychotic Medications:

LBD: According to the Lewy Body Dementia Association, “Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome (NMS), which can be fatal. (NMS causes severe fever, muscle rigidity and breakdown that can lead to kidney failure.)

Alzheimer’s: While anyone who takes an antipsychotic medication has a small risk of developing neuroleptic malignant syndrome, individuals with Alzheimer’s are not nearly as prone to developing the extreme sensitivity to antipsychotic medications that people with LBD demonstrate.
 

Disease Progression:

LBD: According to research conducted by James E. Galvin, MD, MPH and other researchers at the Washington University School of Medicine, the median survival time for those in the study with LBD was 78 years old, and survival after onset of Lewy body dementia was 7.3 years.

Alzheimer’s: In the above referenced study, the median survival time for participants with Alzheimer’s was 84.6 years old, and the survival rate after the beginning of symptoms was 8.4 years. It has been suggested that the difference in the disease progression between LBD and Alzheimer’s can partially be explained by the increase in falls, and therefore injuries and hospitalizations, in those with LBD.
 

Gender:

LBD: Men have a higher chance of developing LBD than women do.

Alzheimer’s: Women have a slightly higher chance of developing Alzheimer’s.

Sources:

Dementia SOS: Colorado's Dementia News and Resource Center. The difference between Alzheimer’s and Lewy body dementia. Accessed June 25, 2012. http://coloradodementia.org/2012/01/20/the-difference-between-alzheimers-disease-and-lewy-body-dementia/

Emory University. Alzheimer’s Disease Research Center. Lewy Body Dementia. Accessed June 25, 2012. http://med.emory.edu/ADRC/dementias/lewy_body_dementia/index.html

Lewy Body Dementia Association. Treatment Options. Accessed June 25, 2012. http://www.lbda.org/content/treatment-options

Lewy Body Dementia Association. Is It LBD or Something Else? Accessed June 25, 2012. http://www.lbda.org/node/8

Neurology. Survival and mortality differences between dementia with Lewy bodies vs. Alzheimer disease. Accessed June 25, 2012. http://www.neurology.org/content/67/11/1935.abstract

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