Lewy body dementia odds over Alzheimer’s disease increase with visual hallucinations. Visual hallucinations occur in 32 to 85 percent of autopsy-confirmed cases of Lewy body dementia (LBD). Alzheimer’s disease patients too can experience hallucinations, but they are less frequent and typically occur in the later stages of Alzheimer’s disease. A study examined the onset of visual hallucinations within five years of developing dementia and found that his factor increases the odds of confirmed Lewy body dementia four to five times over Alzheimer’s disease.
The research team from the Mayo clinic examined brain tissue samples from autopsied individuals with a well-documented history of dementia, who had died within the last three years. The study consisted of 41 confirmed LBD cases, 70 confirmed Alzheimer’s disease cases, and 14 cases of Alzheimer’s disease and amygdala-predominant Lewy bodies. Next of kin received questionnaires to uncover when dementia began in the patients, along with approximate time of start of hallucinations, misperceptions, and misidentification of family members.
LBD patients lived fewer years compared to the Alzheimer’s disease patients, and hallucination onset was earlier in LBD patients than Alzheimer’s disease patients as well. There were no noted differences between types of hallucinations, with people and animals being the most common.
Earlier onset of visual hallucinations was found to be associated with higher Lewy body density and greater density of neurofibrillary tangles of Alzheimer’s disease in the amygdala-predominant Lewy bodies group.
The researchers pointed to the importance of timing of hallucinations, misperceptions, and misidentification of family members in diagnosis of dementia. Furthermore, if hallucinations began within the first five years of dementia, it is more likely to be an indicator of LBD as opposed to Alzheimer’s disease. This can help practitioners to diagnose LBD more accurately.
Hallucinations in Lewy body dementia, treatment, and support
Hallucinations can be an early sign of Lewy body dementia or be part of the disease. If discovered early on, treatment can work well in order to improve hallucinations as well as slow down the progression of the disease. Generally, it is not advised to try and convince a person with Lewy body dementia or Alzheimer’s disease that their hallucinations are not real, as it can contribute to distress. Some family may gently acknowledge that they do not see what the patient sees, but understand that they see it.
Treatment of hallucinations in Lewy body dementia can be similar to treatment of hallucinations in other types of dementia, except that in LBD there is no use of antipsychotic medications, as patients are severely sensitive to these drugs and can have life-threatening reactions. Furthermore, medications like carbidopa/levodopa, which are typically prescribed for movement challenges, can worsen hallucinations.
Some research has shown the benefits of cholinesterase inhibitors, which are FDA-approved to treat Alzheimer’s disease and other forms of dementia.
Family support is the biggest factor when it comes to treatment of hallucinations in LBD. Like any other form of dementia, a whole family becomes affected when a loved one develops the condition. Caring for a dementia patient can be emotionally and physically exhausting, so having a large support group can help lessen the stress. Family members, too, should seek support from groups, therapy sessions, and even doctors in order to better cope and improve care for their loved one.
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