Alzheimer’s disease and Lewy Body dementia are similar and yet significantly different.  Those differences are the hall marks of Lewy Body dementia. Because Alzheimer’s disease represents  the largest amount of people identified as having dementia, it may be assumed early on that this is the disease process the elder has. However once the elder begins to exhibit the classic signs of Lewy Body dementia, it becomes easier to diagnose.

Lewy Body dementia can have fluctuating attention and alertness. Person’s with Alzheimer’s disease have a ongoing progression of the disease without fluctuation. Clara was assumed to have Alzheimer’s disease, when one day when entering her room in the nursing home, Clara clearly asked “Where am I?” The nursing assistant then had a nice conversation with Clara, (who before this had only spoken in non-sensical word salad) while we called her daughter, telling her to come now to visit Clara. Clara maintained this higher level of function for the rest of that day.

Persons with Lewy Body dementia will often have visual hallucinations. While the person with Alzheimer’s disease can have hallucinations they are the result of other disease processes. The person with Lewy Body dementia may or may not be disturbed by these hallucinations. Sometimes the hallucination presents in a similar way to the child who has an imaginary friend, not in any way causing alarm.

The person might also appear to  have hallucinations during sleep. However these night terrors are usually identified as a REM sleep behavior disorder. The person may start to yell, scream, punch, fight, thrash, kick, get up and pace or even run around, and at times fall out of bed all the while appearing to be asleep. This is a very difficult part of the disease process for the caregiver to still manage at home.

Lewy Body dementia will resemble Parkinson’s disease with movement problems; stiffness, slowness, rigidity and difficulty walking. A rule of thumb has always been that a person with Parkinson’s disease might not have Lewy Body dementia, but person’s with Lewy body dementia will have Parkinson symptoms.

There is a saying in healthcare when working with a patient with Lewy Body dementia to “go with the flow.” Every day might be different and it is the caregiver who needs to adjust, the patient can’t.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing