mental health

Says patients prone to physical, sexual abuse

Disorder incurable, expensive to manage

Blames untreated hypertension, smoking, others 

By Sola Ogundipe and Chioma Obinna

There is nothing strange about Lewy Body Dementia, LBD, if explanations bby psychiatrists are anything to go by. They describe it is a type of behavioural condition that progresses faster than other kinds of dementia where memory loss is irreversible.

Good Health Weekly reports.

The media space has been awash by so many remarks and questions since the admission by  veteran Nollywood actress, Joke Jacobs, that her husband Olu, also a veteran actor, is down with Lewy Body Dementia, LBD.

This disease condition which experts are yet to determine the causes, has gained more attraction, and is raising a number of unanswered questions on social media and traditional media.

The level of public interest in the country about the relatively unknown debilitating illness has increased tremendously.

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 Joke explained that her husband who has been off the movie scene in recent times but was recently sighted at the Africa International Film Festival Awards (AFRIFF), looking frail, had actually been battling with LBDfor a couple of years.

Although It is not known just how many Nigerians suffer from the disorder, which is a form of dementia, experts say because of its signs and symptoms such as hallucinations and body rigidity, LBD is often misdiagnosed as dementia, even though in the end it robs people of their cognitive abilities and their memories.

Good Health Weekly spoke to DrAdesojiGbadeboOlabanji, a Consultant Psychiatrist at The Retreat Healthcare, Lagos, 

Adesoji, in his remark, explained that Lewy Body Dementia (also called Lewy body) is basically a progressing brain disease characterised by loss of memories and also behavioural symptoms like hallucinations, illusions and confusion, loss of awareness and sometimes amnesia.

The medic explained that LBD occurs as a result of a kind of protein that is built up in the brain of people with dementia and that separates it from other kinds of dementia.   

“Like other kinds of dementia, people with Lewy body as in the case of Olu Jacobs, tendto lose weight and present with frail body because they usually forget to eat and become dehydrated a lot contributing  to their frail condition.

No known cure

He said although the condition is not curable, it can be managed.

“What you can do is just manage.  With dementia, which is a behavioural problem, they don’t sleep well.   Their gait and balance can be difficult and they might start to shake and all of that.

“They can have hallucinations and delusions that people want to attack them etc.  Those symptoms can be treated but the issue is that you cannot reverse memory loss.    

Early diagnosis crucial

“You can reduce the rate at which it is going.  For instance, if it is diagnosed early, with management you can reduce the progression by 15 – 20 per cent and there are certain kinds of medications you can give that can reduce the rate of the loss, but you can’t reverse the loss.

“It will not cause death but the problem is that people with dementia tend to live far less than people without dementia. 

“For instance, if you have two 65-year-olds, one with dementia and the other one without dementia, within five to six years, the person with dementia would be practically gone. 

“It is a brain disease because the brain controls everything and you are losing neurons in the brain, and as you are losing neurons, that part of the brain controlling your body is shutting down.  So these patients tend to not live as long as people of their age.”

Who is at risk

Lamenting that scientists are yet to discover causes of Lewy body, Adesoji said: “Except for vascular dementia that we know with people who have hypertension and diabetes they can develop dementia later in life when it has been there for a long time.  

“We don’t know why but we do know that people who have had Parkinson disease have a higher rate of developing Lewy body dementia.”

He warned that although there is nothing that individuals can do to prevent dementia or Lewy body, not everyone from families in which dementia runs would develop it.

Adesoji warned that risk factors such as smoking, alcohol intake, untreated hypertension, Parkinson disease can lead to Lewy body.

“Individuals with Parkinson disease, hypertension and diabetes should treat the conditions well and get them under control because if you don’t then it is more likely that you will have Lewy body later on. “

Further, he said researchers claim that there are memory exercises that can reduce the rate at which dementia will occur.  

“Try and calculate more, make sure that your mind is more active no matter how old you get. But the truth is that certain people will have dementia and some people will not even though they are from the same family. 

Awareness essential

Should Nigerians be generally worried about Lewy body? Adesoji said: “It is something that people should be aware of because quite a number of people in the rural areas have been tagged witches and killed.   

“Most of the time, when we investigate, these women actually have dementia.  They claim things that are not true but they are just claiming them as they feel bad about themselves because they have lost their memory.  

“It is important that people obtain the correct  information because one thing with Lewy body dementia is that it progresses faster than the other kind of dementia.  The memory problem is a little different from other kinds of dementia.    

Memory loss

“With Lewy body, it is like an episode. A person loses memory, regains it and loses it again, while for the other kind of dementia,  it gradually goes down and you can see that a person never goes back to how he was.

“If for instance, a person was a teacher, with Lewy body, you would observe that there would be some days that he or she can take the class and some days he or she cannot. It is like the stop-start, star-stopthing.   

“With other kinds of dementia, the memory just gradually reduces to the point where it cannot even remember the lesson notes and then stops permanently, even as other things like hallucinations will come up.

Weightloss

“It does not reduce weight but with Lewy body dementia, they forget and tend to not eat and tend to dehydrate easily because they don’t remember.  They forget the names of their loved ones, their houses or their addresses. 

“They can’t remember the  basic information for instance you leave your phone on the table,  and cannot remember where the phone is   that is why we have people that care for them around them 24 hours a day and seven days in the week.”

Burden of care

Lamenting that a number of patients with the condition are roaming the streets of Lagos, Adeniji stated: “For them not to get missing walking around.  There is quite a number of Lewy body patients on the street of Lagos.  We have found a lot of them and they cannot remember where they live, even their names and family members. They are just like that all over Lagos and all over Nigeria.

“First, those affected need a lot of people around them and it is a lot of work caring for them.   You cannot have one person caring for them. You need to get professionals as soon as you notice a change in memory and it is dramatic. 

” You need to get them to see a doctor as quickly as possible.   You need to surround them with things that are familiar because when you change their environment suddenly, that also can trigger their episode of issues. Ensure that the people caring for them don’t get tired of them. 

Prone to abuse

“We have what we call elderly abuse.  Where people caring for these patients abuse them and so there is the need to supervise those caring for them.   Some carers abuse them physically and even sexually because they cannot remember what happened to them. So people that care for them have to be supervised closely even if they are placed in a facility,  you must make sure that they are not abused. “

High cost of treatment

Cost of treatment of Lewy body is high according to the expert. He said it is costly to manage the disorder because some of the medications are quite expensive and it is also not cheap to afford the caregivers.

Facts about Lewy body dementia

It is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behaviour, and mood. Lewy body dementia is one of the most common causes of dementia.

Who is at risk

People typically show symptoms at age 50 or older, although sometimes younger people have it and it slightly affects men more than women.

Lewy body can occur alone or along with other common brain disorders, however, it is a progressive disease, meaning the symptoms start slowly and worsen over time.

How it presents

A person may suffer the disease for five to 20 years from the time of diagnosis.

Health experts note that in the early stages, the symptoms can be mild, and persons affected can function fairly normally. But as the disorder advances, the patient would require more help due to a decline in thinking and movement abilities. In the later stages, the patient may be totally dependent on others for assistance and care.

While the symptoms of Lewy body respond to treatment for a period of time, there is currently no cure although research is improving its understanding .

Common causes

The commonest risk factor for Lewy body is age. No specific lifestyle factor has been proven to increase risk but other known risk factors include Parkinson’s disease and sleep behaviour disorder.   Having a family member with the disorder also may increase risk, although it is not considered a genetic disease.

Signs and symptoms

The most common symptoms include changes in cognition, movement, sleep, and behaviour. Lewy Body Dementia causes changes in thinking abilities that may include visual hallucinations, that is, seeing things that are not present, and nonvisual hallucinations, such as hearing or smelling things that are not present.

Unpredictable changes in concentration, attention, alertness, and wakefulness sometimes throughout the day as well as severe loss of thinking abilities that interfere with daily activities. Some people with LBD may not experience significant movement problems for several years among others

Behaviour and mood symptoms

Changes in behaviour and mood are possible in LBD and may worsen as the person’s thinking abilities decline.  Agitation, or restlessness, and related behaviours, such as pacing, hand wringing, an inability to get settled, the constant repeating of words or phrases, or irritability are common.

The patient may be delusionary, for example, a person may think his or her spouse is having an affair or that relatives long dead are still living among others.  

Diagnosis

Expertssaythediagnosiscanbechallengingasearlysymptomsareoftenconfusedwithsimilarsymptomsfoundinotherbraindiseasesorinpsychiatricdisorders.

There are two related diagnoses – dementia with Lewy bodies (DLB) and Parkinson’s disease dementia. Both diagnoses have the same underlying changes in the brain and, over time, people with either diagnosis develop similar symptoms. The difference lies largely in the timing of cognitive (thinking) and movement symptoms.

Treatment

While Lewy body currently cannot be prevented or cured, some symptoms may respond to treatment for a period of time. An LBD treatment plan may involve medications, physical and other types of therapy, and counselling. A plan to make any home safety updates and identify any equipment can make everyday tasks easier.

A skilled care team is often required to improve the quality of life for the patients. After receiving a diagnosis, a person with LBD may benefit from seeing a neurologist who specializes in dementia and/or movement disorders.

Care and support

Depending on an individual’s particular symptoms, physical, speech, and occupational therapists, as well as mental health and palliative care specialists, can be helpful.

The first step is to visit a doctor to see if a medical condition unrelated to Lewy body is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers (bed sores), and constipation can worsen behavioural problems and increase confusion.

Certain medications, such as anticholinergics and antihistamines may also cause behavioural problems.  For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions.  

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