Alan Dengiz M.D. CMD
Dementia with Lewy bodies (DLB) is considered to be the third most common form of dementia after Alzheimer’s disease (AD). There are specific distinctions, which can help you and your physician differentiate between the two. AD tends to start with short-term memory problems but DLB begins with sleep, behavioral and personality changes before memory impairment becomes obvious.
The memory loss in AD is prominent early on and is caused by difficulty learning new information, but in DLB the memory loss occurs later and is related to difficulty retrieving previously learned information, and the person may be helped by cueing or reminders. In DLB there is more significant impairment in executive function early on such as inability to complete tasks and marked disorganization of daily activities.
Visual hallucinations and delusions tend to be a relatively early finding in DLB and are quite vivid and detailed. Those with DLB may see children, animals or other people in the room with them. The husband of one of my DLB patients would come home to find his wife serving dinner to imagined guests.
In contrast, in AD hallucinations are less common, occur later in the disease and the delusions occur because of their memory loss, such as accusing people of stealing their belongings when they have misplaced them and forgotten where they were placed—often in a completely inappropriate place or in the trash. Depression and anxiety are common in both disorders but another significant distinction between the two is that AD generally follows a slow steady progressive course, but in DLB there can be significant fluctuations in mental status from day to day. This can be dramatic, ranging from relatively clear and coherent to severe confusion.
As DLB progresses the motor features seen in Parkinson's disease (PD) begin to develop, such as walking with a short shuffling step, rigidity of the body with a forward stoop, and lack of expression in the face (masked face). Most experts in the field of dementia believe that DLB is part of the spectrum of Parkinson's disease. If the individual is treated with Parkinson’s drugs used for improving these movement problems, they are likely to be ineffective and may make the memory and behavioral problems worse. The evaluation for someone with DLB is the same as for someone with AD but the diagnosis is a clinical one since there are no specific tests that reliably distinguish between the two. Autopsy examination of the brain does show distinctions between the two disorders, the name Lewy body is related to specific pathologic changes that are different from those seen in AD.
Fortunately clinical experience and research has shown that the medications known as cholinesterase inhibitors, especially Exelon, can be beneficial for patients with DLB. These drugs may reduce the frequency and severity of cognitive fluctuations and behavioral problems.
Alan Dengiz M.D. CMD
Since 1984, Alan Dengiz M.D. has been Director of Geriatric Medicine at St. Joseph Mercy Hospital and Health System in Ann Arbor, Michigan. He is also Medical Director of Glacier Hills Retirement Community and Huron Woods Alzheimer's Residential Care Center. He previously served on the faculty of The University of Michigan Medical School, Ann Arbor Michigan and Washington University School of Medicine, St. Louis, Missouri.
Dr. Dengiz received his medical degree and training at the University of Michigan Medical School. He is Board certified in Internal Medicine, Geriatric Medicine, Hospice and Palliative Medicine and is a Certified Medical Director. He has a major interest in the diagnosis and management of Alzheimer's disease and related disorders. Dr. Dengiz has been involved in clinical research in Alzheimer’s Disease and other areas of Geriatric Medicine. He has lectured nationally on topics such as Alzheimer's disease, Dementia, Osteoporosis, and Successful Aging.
Most recently Dr. Dengiz has appeared in the in the PBS series “Second Opinion” which focused on caregivers of people with Alzheimer's disease. He also did a national media tour with actor, Hector Elizondo to raise awareness of caregiver stress in caring for those with Alzheimer's disease.
Dr. Dengiz was recognized by “HOUR Detroit Magazine” as a top Geriatric and Alzheimer's diagnostic physician (2000-2008) and was named among the best Geriatric and Internal Medicine physicians in the “Best Doctors in America” (2001-2008). He was also honored as the Michigan Geriatrician of the Year and received the Outstanding Geriatric Community Service Award.
