LEWY BODY DISEASE

 Frederick Lewy was a German neuropathologist who worked with Alzheimer, and in 1912 described the spherical neuronal inclusion bodies found in some patients with dementia.

These ‘Lewy bodies’ are characteristic of Lewy body disease, which has three main clinical manifestations:

1 Parkinson’s disease

2 dementia with Lewy bodies;

3 autonomic failure associated with degeneration of sympathetic neurons in the spinal cord.

There is a cross-over between the three syndromes, as many patients with Parkinson’s develop both dementia and autonomic dysfunction in their latter years.

PATHOLOGY-  There is usually a mixture of Lewy bodies and Alzheimertype amyloid plaques and tangles. Lewy bodies are dense, intracytoplasmic inclusions made of phosphorylated neurofilament proteins, associated with ubiquitin and alpha-synuclein. These are primarily found in the basal ganglia, and later spread into the cortex. Neuronal loss is prominent, and there is a slight reduction in total brain volume.

CLINICAL FEATURES

• Dementia—relative sparing of memory, with fluctuating cognitive ability and level of consciousness is typical.
• Parkinsonism—postural instability and shuffling gait; only 20 per cent have a tremor.
• Visual hallucinations.
• Falls
• Dipression
• Sleep disorders—daytime somnolence.

Prevalence - Lewy body dementia accounts for 10–15 per cent of dementia cases. The prevalence is 0.7 per cent in over 65s, rising to 5.0 per cent in over 85s. It is more common in men than women.

 Aetiology - The cause of Lewy body dementia is unknown, but once again family history is a key risk factor, and rare familial types have been found. No environmental risk factors have been identified.

Course and prognosis Life expectancy for Lewy body dementia is 4–10 years, with the rate of cognitive decline similar to that in Alzheimer’s. Frequently, the early stages are only recognized in retrospect, but function can be much more impaired than in other dementias due to pronounced parkinsonism affecting movement.

Perceptual and behavioural disturbance can be severe in the later stages of the illness, with antipsychotic medications often needed. A high proportion of these patients will enter residential care by this stage.

HOMOEOPATHIC MANAGEMENT:

1. Nux Vom:This homeopathic medicine is used in cases of dementia where the patient is extremely sensitive to the words and actions of others and is always seeking attention. There is suicidal tendency in the patient and he also is inclined towards killing friends. Although suicidal, the patient does not have the courage to perform the act. Extreme irritation is noticed. The patient becomes vindictive and quarrelsome in nature.
2. Mercurius:This homeopathic medicine is given to patients with dementia who have lost all sense of decency. They become filthy and develop a groveling mentality. Memory weakens to a great extent and the patient has problems with vision, unpleasant breath odour and a heavily coated tongue.
3. Ignatia: This homeopathic medicine is given to people who have extreme sensitivity of the mind, which further leads to depression and grief. This may occur due to failure in love relationships.
4. Calcaria Carb: Calcaria Carb is an effective homeopathic medicine used in cases of dementia where the brain and other organs do not develop properly. The patient becomes forgetful and very slow in learning something.
5. Lycopodium:This medicine is used when the dementia affected people experience great depression, become despondent and constantly worry about themselves and their activities. They become fearful, irritable and angry. Constipation is also observed in such cases
6. Staphisagria: Staphisagria is used to treatment dementia characterized by sleeplessness. The patient becomes cowardly and is full of shamefulness, disgust, humiliation and shyness. He would rather be alone than have company.
7. Chamomilla:This is another homeopathic medicine for treating dementia with acute sensitiveness. Irritation and peevishness are common, and the patient tends to get angry very easily.