A closer look at DLB symptoms

As we’ve learned from Dr John-Paul Taylor, some of the symptoms of dementia with Lewy bodies (DLB) mean that there are particular challenges to care and connect with someone affected by the condition. We take a closer look at two of these symptoms: cognitive fluctuation and visual hallucination.

Cognitive fluctuation

Cognitive fluctuation has an impact on a person’s attention and alertness. It is experienced to some extent by people living with all major causes of dementia, but it is a characteristic symptom of dementia with Lewy bodies, affecting around 90% of people with the condition. Changeability in a person’s attention and alertness can have a functional impact on activities of daily living, and makes planning ahead really difficult. Some characteristics of cognitive fluctuation include:

  • drowsiness or lethargy all of the time or several times of day
  • daytime sleep of two hours or more
  • staring into space for long periods
  • times when a person’s flow of ideas seem more disorganised

There is evidence that increasing levels of cognitive fluctuation indicate advancing cognitive decline, though this is not certain. Further research is needed to better understand the causes of cognitive fluctuation, and how to assess cognitive fluctuation clinically.

Visual hallucinations

Visual hallucinations are another core feature of DLB, though can occasionally occur in other forms of dementia such as Alzheimer’s. A person with DLB is more likely to experience multiple visual hallucinations, and may sometimes hear their visual hallucinations speak. It is also more common to experience these hallucinations in the evening.

Research has found that the most common themes for hallucinations are of people, animals, objects, children and insects. These are usually complete, of normal size and can even be moving. Men can sometimes see machinery, whilst women are more likely to see family and children, which suggests the hallucinations are drawn from personal experiences. People can experience shadows at their shoulders, or sense a ‘presence’ in the room which can lead to a delusion that a stranger is living in their home. This can mean that hallucinations are sometimes accompanied by false beliefs and delusions.

One important issue for people with DLB is increased sensitivity and adverse reactions to a form of tranquilising drugs known as neuroleptic medicines or antipsychotics, so it is important that these are not given to someone with DLB.

In Week 2, we’ll be looking again at some of the symptoms of DLB, focusing on their impact on the way we communicate. We’ll also think about how we might respond in ways that are appropriate to someone living with this condition.

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Dementia Care: Staying Connected and Living Well

Newcastle University

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