Memory Disorders

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by 

Andrius Baskys, MD, PhD

Alzheimer’s disease, or Alzheimer’s, is the most common type of dementia, making up 60% to 70% of all dementia cases. It is a brain disease that gets worse over time. It often starts with trouble remembering recent events, also called short-term memory loss. As it gets worse, people may have trouble speaking, feel confused or lost, have mood swings, lose interest in things, or have difficulty taking care of themselves. They may also change how they act and pull away from family and friends. Over time, the body stops working properly, and people need full-time care. On average, people live three to nine years after being diagnosed, but this can vary.

What causes Alzheimer’s disease?

The exact cause of Alzheimer’s disease isn’t known, but it is most likely linked to brain aging, which is the biggest risk factor. Other risks include past head injuries, depression, or high blood pressure. Doctors diagnose Alzheimer’s by looking at a person’s medical history and using memory and thinking tests, along with DNA tests, blood tests, and brain scans to rule out other causes.

Alzheimer’s disease risk 

Like many illnesses that happen later in life, Alzheimer’s disease has many causes. Both genes and the environment play a role. Risk factors are grouped into two types: "modifiable" (things you can change) and "non-modifiable" (things you can’t change).

Modifiable risks include high blood pressure, high cholesterol, high blood sugar, being overweight, not exercising, depression, and smoking. Non-modifiable risks include family history, past brain injuries, low education levels, a history of heart attack or stroke, and genetics. While we can’t reduce all risks, some can be lowered or even removed, which helps decrease overall disease risk. Genetic testing, like checking for APOE gene variants, can also improve the accuracy of your risk estimate. Two new drugs have been recently approved to treat Alzheimer's and their usefulness depends on a person's APOE genotype.

Are you at risk for Alzheimer’s? 

To answer this question, use our service to estimate your genetic risk for Alzheimer's. Genetic testing for important variants in genes associated with Alzheimer’s (for example APOE) can significantly improve the accuracy of the risk determination and provide you with strategies for the disease risk reduction.

Treatment

There are no treatments that stop or reverse memory loss associated with Alzheimer’s disease. Those affected increasingly rely on others for assistance, often placing a burden on the caregiver, which often leads to caregiver burnout. Exercise programs are beneficial with respect to activities of daily living and potentially improve outcomes. Medications such as Donepezil, Rivastigmine, Galantamine, Memantine may provide a temporary relief. There are two new drugs for Alzheimr's, Lecanemab (Leqembi) and Donanemab (Kisunla), both of which are known to increase a risk of significant side effect in patients who are APOE e4 genotype carriers.

The most important aspects of Alzheimer’s disease treatment is the correct diagnosis to rule out any treatable causes of memory impairment: depression, lack of vitamins, medication side effects and others. As with most medical conditions, a timely evaluation by a physician specializing in diagnosis and treatment of memory disorders is the best approach to assuring the optimal outcome of a memory problem.

by

Andrius Baskys, MD, PhD

Lewy body disease (LBD), also known under a variety of other names including dementia with Lewy bodies (DLB), diffuse Lewy body disease, cortical Lewy body disease, and senile dementia of Lewy type, is a type of dementia closely associated with Parkinson’s disease. Lewy body dementia affects 1.3 million individuals in the United States alone.

Signs and Symptoms

Lewy body dementia (LBD) primarily affects older adults. Its main feature is cognitive decline and hallucinations, as well as varied attention and alertness. Persons with LBD show markedly fluctuating cognition. Wakefulness varies from day to day, and alertness and short term memory rise and fall. Persistent or recurring visual hallucinations with vivid and detailed pictures are often an early diagnostic symptom. Falls are common. REM sleep behavior disorder (RBD) is a symptom often first recognized by the patient’s caretaker. RBD includes vivid dreaming, purposeful or violent movements while asleep, and falling out of bed.

Visual Hallucinations in LBD

Visual hallucinations in people with LBD most often involve seeing people or animals that are not there. These hallucinations are not necessarily disturbing and in some cases, the person with LBD may have insight into the hallucinations and even be amused by them or aware they are not really there. People with LBD may also have problems with vision, including double vision and misinterpretation of what they see, for example, mistaking a pile of socks for snakes or a clothes closet for the bathroom.

LBD, Alzheimer’s and Parkinson’s Diseases. 

LBD symptoms overlap clinically with Alzheimer’s disease and Parkinson’s disease. Because of this overlap, LBD in its early years is often misdiagnosed. However, whereas Alzheimer’s disease usually begins gradually, LBD frequently has a rapid or acute onset, with especially rapid decline in the first few months. Thus, LBD tends to progress more rapidly than Alzheimer’s disease. Despite the difficulty, a prompt diagnosis is important because of the risks of sensitivity to certain neuroleptic (antipsychotic) drugs and because appropriate treatment of symptoms can improve life for both the person with LBD and the person’s caregivers.

Treatment

LBD is distinguished from Parkinson’s disease dementia by the time frame in which dementia symptoms appear relative to Parkinson symptoms. Parkinson’s disease with dementia (PDD) would be the diagnosis when dementia onset is more than a year after the onset of Parkinson’s. LBD is diagnosed when cognitive symptoms begin at the same time or within a year of Parkinson symptoms.Certain medications could be extremely harmful to patients with LBD. Benzodiazepines, anticholinergics, surgical anesthetics, some antidepressants, and over the counter cold remedies can cause acute confusion, delusions and hallucinations.

One of the most critical and distinctive clinical features of LBD is hypersensitivity to neuroleptic and antiemetic medications. In nearly 50% of cases, a patient treated with these drugs could lose cognitive function completely or develop life-threatening muscle rigidity, and die. Some commonly used drugs which should not be used for people with LBD are chlorpromazine, haloperidol, or thioridazine, risperidone, olanzapine and aripiprazole.

There is no cure for LBD. Treatment may offer symptomatic relief, but remains palliative in nature. Due to hypersensitivity to neuroleptics (drugs to treat hallucinations and delusions), people with LBD are at risk for neuroleptic sensitivity syndrome, a life-threatening condition. Other medications, including drugs for urinary incontinence and the antihistamine medication Benadryl can also exacerbate dementia. As with most medical conditions, a timely evaluation by a physician specializing in diagnosis and treatment of memory disorders is the best approach to assuring the optimal outcome of a memory problem.