Here’s a link to the eMedicine.com overview on Dementia with Lewy Bodies (DLB):
http://emedicine.medscape.com/
It was last updated on July 5, 2005.
I think these eMedicine articles are great. They can definitely be challenging reading given the use of medical terminology. But eMedicine.com is often the first place I go for comprehensive info on all aspects of various disorders, including DLB.
This post will be of interest to those dealing with dementia-related behavior, such as wandering and aggression.
Besides wandering and aggression, this article, “Understanding Behavioral Changes in Dementia,” also discusses sundowning, exercise, and finding caregivers. The authors give tips for managing behavioral changes, using routines, communicating, moving someone with dementia to a new home, and caring for yourself (the caregiver).
The article was written by Tanis Ferman, PhD. Dr. Ferman, a clinical neuropsychologist at Mayo Jacksonville, is on the LBDA Scientific Advisory Council.
You can find this terrific article online at:
https://web.archive.org/web/20070308085114/http://www.lewybodydementia.org/AR0507TJF.php
Gastroparesis, or delayed gastric emptying that causes bloating, regurgitation, and early satiety, can be a problem in the neurodegenerative disorders in our group, especially in MSA and LBD. Gastroparesis can lead to weight loss and dehydration.
One gentleman in our local support group with a clinical diagnosis of MSA but a pathologically confirmed diagnosis of LBD had gastroparesis. It was the worst symptom he had.
Online friend Vera James posted to an MSA-related Yahoo!Group a link to a terrific article on gastroparesis. Here’s a link to the article, available at no charge:
www.practicalgastro.com/pdf/December06/WoArticle.pdf
Motility and Functional Disorders of the Stomach: Diagnosis and Management of Functional Dyspepsia and Gastroparesis
Practical Gastroenterology
December 2006
by John M. Wo and Henry P. Parkman
See pages 37-45 especially.
The section on “Treatment” is particularly good. These points are discussed in detail:
* eating smaller, more frequent meals
* relying on liquid nutrient
* limiting fatty foods
* avoid salads, raw foods, and red meat
* antiemetic medications. “The most commonly prescribed traditional antiemetic drugs include promethazine and prochlorperazine.”
* prokinetic medications such as metoclopramide, domperidone (not available in the US), and erythromycin.
* botulinum toxin injection
* gastric electrical stimulation
* jejunal feeding, rather than PEG feeding
I’ve copied below the “Gastroparesis Cardinal Symptom Index.”
Robin
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Table 4. The Gastroparesis Cardinal Symptom Index
1. Nausea (feeling sick to your stomach as if you were going to vomit or throw up)
2. Retching (heaving as if to vomit, but nothing comes up)
3. Vomiting
4. Stomach fullness
5. Not able to finish a normal-sized meal
6. Feeling excessively full after meals
7. Loss of appetite
8. Bloating (feeling like you need to loosen your clothes)
9. Stomach or belly visibly larger
Each symptom is graded by the patient on a 0 to 5 scale: 0=none; 1= very mild, 2=mild, 3=moderate, 4=severe, 5=very severe.
From Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J. Aliment Pharm Ther, 2003;18:141.
I saw this second post last week by Angela Taylor, the president of the Lewy Body Dementia Association, in a couple of places. She mentions these medications for which I’m adding the brand names (in parentheses): donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, which used to be called Reminyl).
Robin
———————
Anesthesia and LBD
Posted by: “jaektaylor”
Date: Thu Jan 11, 2007
We’ve all talked about how our loved ones respond poorly to most
anesthesia. The following verbiage is going to be included in the
next version of the LBDA’s informational pamphlet. Here it is for
you, before it’s even ‘hot off the presses!’
“When considering any surgery, caregivers should meet with the
anesthesiologist in advance. People with LBD often respond to certain
anesthetics and surgery with acute confusional states (delirium)
and/or may have a precipitous drop in functional abilities which may
or may not be permanent. The pros and cons of stopping donepezil,
rivastigmine, or galantamine should be carefully considered. If a
spinal block or regional block can be used instead of general
anesthesia, this would be preferred as those methods are less likely
to result in postoperative confusion.”
I saw this post last week by Angela Taylor, the president of the
Lewy Body Dementia Association, on the LBDcaregivers online
discussion group. The topics are excessive daytime sleepiness and
the use of the medication Provigil.
Robin
———————
Treating excessive daytime sleepiness/Provigil
Posted by: “jaektaylor”
Date: Thu Jan 11, 2007 6:02 am ((PST))
….The LBDA’s Scientific Advisory Council is also writing a short
overview on the issue of excessive daytime sleepiness, and the use
of psychostimulants like Provigil. The paper isn’t ready for
release to the public yet, but here are a few things that I’ve come
to understand as a lay caregiver that may be of help.
1. The use of psychostimulants does not appear to be a common
treatment in LBD, and should be done with caution. A neurologist
who specializes in sleep disorders might be the best person to
manage this type of medication.
2. There are a number of reasons that patients may experience
excessive sleepiness, which should be addressed BEFORE considering
using psychostimulants, like depression, delirium, inactivity, etc.
3. With the use of psychostimulants, there are some risks of
increased psychosis in some patients. Fluctuating pulse and blood
pressure and falls is also a risk.
4. A full sleep evaluation is recommended before using
psychostimulants to address what other sleep disorders may be
contributing to the problem, that wouldn’t be resolved by the use of
a psychostimulant.
Hope that helps,
Angela
