10.15.16 DeMystifying Alzheimer’s with Mary Yamin-Garone
Good afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.
Today I’ll be talking about medications and treatments for Lewy Body Dementia.
Presently, there is no way to prevent LBD nor is there a cure. However, some symptoms may respond to treatment, at least for a while. An all-inclusive treatment plan may involve medications, different types of therapy and counseling.
Some drugs used to treat Alzheimer’s also can treat the cognitive symptoms of LBD. These drugs, known as cholinesterase inhibitors, act on a chemical in the brain that’s important for memory and thinking. They also may improve behavioral symptoms.
The U.S. Food and Drug Administration (FDA) approves specific drugs for certain uses after thorough testing and review. Doctors can, however, prescribe a drug for any use if they believe it will help their patient. The FDA has approved one Alzheimer’s medication, Exelon, to treat cognitive symptoms in Parkinson’s disease dementia. Possible side effects include nausea and diarrhea.
Lewy Body Dementia-related movement symptoms can be treated with a Parkinson’s medication called Sinemet. It can make it easier for an LBD sufferer to walk, get out of bed and move around. Side effects include hallucinations and other psychiatric or behavioral problems. Because of this risk, it may not be recommended for mild movement symptoms. If prescribed, Sinemet usually starts with a low dose and is increased gradually. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.
Behavioral and mood problems can be caused by a variety of things, including hallucinations or delusions, pain, illness, stress or anxiety, not being able to express frustration or fear or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Some behavioral problems can be managed by making changes in the individual’s environment and/or treating medical conditions. Others may require medication.
The first step is to see your physician to determine whether a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, bed sores and constipation can cause behavioral problems to worsen suddenly.
Certain medications used to treat LBD symptoms or other diseases may also cause behavioral problems. For example, some over-the-counter sleep aids, strong pain and bladder control medications and drugs used to treat LBD-related movement symptoms can cause confusion, agitation, hallucinations and delusions. Likewise, some anti-anxiety medicines can increase anxiety in those with Lewy Body Dementia. Check with your doctor to see if any changes in medications are needed.
Not all behavior problems are the result of illness or medications. An individual’s surroundings, such as levels of stimulation or stress, lighting, daily routines and relationships, can be the cause.
Cholinesterase inhibitors may decrease hallucinations and other psychiatric symptoms of LBD. They may have side effects, like nausea, and aren’t always effective. They can, however, be a good first choice for treating behavioral symptoms. These inhibitors don’t affect behavior right away so they should become part of a long-term strategy.
Antidepressants can be used to treat depression and anxiety. Selective serotonin reuptake and norepinephrine reuptake inhibitors, are frequently well tolerated by those with Lewy Body Dementia.
In some cases, antipsychotic medications are necessary to treat LBD-related behavioral symptoms to improve the quality of life and safety of the individual and their caregiver. This type of medication, however, must be used with caution. It can cause severe side effects and worsen movement symptoms.
Sleep problems may increase confusion and behavioral problems. To help alleviate sleeplessness, your doctor can order a sleep study to identify any underlying sleep disorders like sleep apnea, restless leg syndrome and REM sleep behavior disorder.
REM sleep behavior disorder involves acting out one’s dreams, leading to lost sleep. Clonazepam, used to control seizures and relieve panic attacks, is often effective in low doses. It can have side effects such as dizziness, unsteadiness and problems with thinking. Melatonin, a naturally occurring hormone used to treat insomnia, may also offer some benefit when taken alone or with clonazepam.
Increasing exercise or activities and avoiding lengthy or frequent naps can promote better sleep. Avoiding alcohol, caffeine or chocolate late in the day helps, too. Over-the-counter medications also can affect sleep, so review all medications and supplements with a physician.
Other treatment considerations
LBD affects the part of the nervous system that regulates automatic actions like blood pressure and digestion. Low blood pressure, a common symptom, can cause dizziness and fainting. Elevating the legs, using elastic stockings and, when recommended by your physician, increasing salt and fluid intake can help.
Urinary incontinence should be treated cautiously because certain medications may worsen cognition. Constipation can typically be treated with exercise and dietary changes. However, laxatives and stool softeners may be necessary.
Antipsychotic drugs can worsen Lewy Body Dementia symptoms. It might be helpful to start out with other approaches.
- Tolerate the behavior. Often someone suffering from Lewy Body Dementia isn’t distressed by hallucinations. In these cases, the side effects may be worse than the hallucinations.
- Reduce clutter and distracting noise to make it easier for someone with LBD to function.
- Avoid correcting and questioning someone with Lewy Body Dementia. Instead, reassure them and validate their concerns.
- Break down tasks into easier steps and establish structure and routine during the day to lessen confusion.
Frustration and anxiety can worsen LBD symptoms. These techniques may help promote relaxation.
- Listen to calming music
- Use pets to improve moods and behaviors
- Use fragrant plant oils
- Perform massage therapy
Depending on a person’s particular symptoms, other professionals may be helpful.
- Physical therapists can help with movement problems through cardiovascular, strengthening and flexibility exercises, gait training and general physical fitness programs.
- Speech therapists may help with low voice volume and voice projection, poor speaking ability and swallowing issues.
- Occupational therapists help find ways to easily carry out activities of daily living, like eating and bathing, to promote independence.
- Music or expressive arts therapists may provide meaningful activities that can reduce anxiety and improve well-being.
- Mental health counselors can help those with LBD and their families manage difficult emotions and behaviors and plan for the future.
Support groups are another valuable resource. Sharing your experiences and tips with others in the same situation can help identify practical solutions to everyday challenges and get emotional and social support.
That’s all for today. Thanks for listening. I hope this information was helpful.
Join me next time for more Demystifying Alzheimer’s.