▲Frequent sleep talk, gesticulation, fluctuating cognitive function, and visual hallucinations are typical manifestations of dementia with Lewy bodies; the picture is a photo of the situation, and the characters in the picture have nothing to do with this article.

(Photo credit: shutterstock)

Text / Luo Yanyu

Grandpa Li is an 80-year-old veteran of the Air Force. His memory is good and bad. At first, his family thought it was because of his age, so he didn’t care. Even when I woke up from a nap, I couldn't tell if I was still in a dream.

In addition, Grandpa Li often felt that he saw outsiders hiding in the cupboard, and he could even vividly describe it as a Japanese soldier.

When Grandpa Li first came to the clinic, he was in good spirits. Although he was not sure about the date, simple calculations, drawing, and writing were all normal, and his short-term memory ability was also quite good.

His gait is slow, but without tremors or short steps.

The family members said that every time they come to the outpatient clinic to see a doctor, the whole situation will be much better, which is very different from the situation of lying in bed at home.

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Cognitive dysfunction is predominant in males slightly more than females

Grandpa Li's ups and downs in cognitive function, sleep talking at night, and visual hallucinations are typical manifestations of dementia with Lewy bodies. Although it is also a kind of neurodegeneration, it is not Alzheimer's disease, which is mainly short-term memory loss.

The incidence of dementia with Lewy bodies is slightly higher in males than in females and also increases with age.

The brain pathological features of this type of neurodegeneration are the same Lewy bodies (an abnormal protein accumulation in the brain) as our common Parkinson's disease (hand tremors, small steps, stiffness, slow movement, and posture imbalance). ), but because they are mostly distributed in the cortical area, most of them are mainly cognitive dysfunction, and there are many patients with mild Parkinson's symptoms, such as slow movements or hand tremors.

When we pay attention to whether the elderly suffer from dementia, most of the focus is on memory function, so it is easy to ignore this kind of dementia with Lewy bodies that is not mainly caused by memory impairment.

Although the memory of these patients is affected to some extent, what is more serious is the impairment of attention. It is difficult for patients to maintain long-term concentration, which leads to the limitation of many self-care abilities.

Talking in sleep or punching and kicking belong to rapid eye movement sleep behavior disorder. This feature has a very high specificity and is mostly related to diseases such as Parkinson's disease. Some patients are even 10 years before the onset of Lewy body dementia or Parkinson's disease This symptom began in the first year, and it is worth paying attention to early.

The part of hallucinations is also very special, not only visual hallucinations are the main ones, most patients can clearly describe the patterns, and these images are often associated with human heads, black shadows, and small insects.

At present, the diagnosis of dementia with Lewy bodies is still mainly clinical, supplemented by brain imaging, and the dopamine scan will be similar to Parkinson's disease, and the markers of dopamine transporters will be reduced.

▲The dopamine scan shows that the markers of the motor body are reduced.

(Photo provided / Luo Yanyu)

It is very special that the drug used to treat dementia with Lewy bodies is the ethylenecholinease inhibitor we use to treat Alzheimer's disease, and the treatment effect is even better than that of Alzheimer's disease.

In the past, in our treatment experience at Hualien Tzu Chi Hospital, there were many cases where the scores of cognitive tests improved significantly. There were even sporadic patients with severe lethargy as the main manifestation. After the drug treatment, they were quite awake the next day. .

Dementia is a syndrome with many types. Alzheimer's disease is the majority, followed by Lewy body dementia. It was mistaken for general mental illness and missed the chance of treatment.

Once the elderly have sleep talking and hallucinations, we should be alert to the possibility of dementia with Lewy bodies and seek medical treatment in time.

(The author is the Director of Department of Neurology, Hualien Tzu Chi Hospital)

▲Dr. Luo Yanyu explained the dopamine scan results of patients with dementia with Lewy bodies.

(Photo provided / Luo Yanyu)

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• hallucination

• dementia

• Senior citizens

• health care

• Dementia with Lewy bodies

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