Dementia with Levi's little bodies
- Dementia reasons with Levi's little bodies
- Dementia symptoms with Levi's little bodies
- Treatment of dementia with Levi's little bodies
Among neurodegenerative frustration dementia with Levi's little bodies (other name – a disease of diffusion little bodies of Levi) holds a specific place as death of cells in this case is caused by emergence in cortical and subcrustal departments of a brain specific intra cytoplasmatic inclusion ̆ – Levi's little bodies. (However, amyloid plaques and neurofibrilla, characteristic of Alzheimer's disease, can be also present approximately in 30% of cases.) The name these educations were got by the name of their pioneer – the German neurologist F. G. Levi.
Dementia reasons with Levi's little bodies:
Initially Levi's little bodies connected with Parkinson's disease, however in the second half of the XX century (first of all thanks to work of the Japanese researchers) their communication with dementia was shown. It became clear later that dementia cases connected with Levi's little bodies – rather widespread phenomenon (about 15% of all cases of dementia). Among heavy neurodegenerative frustration they concede on frequency only to Alzheimer's disease. Unfortunately, in connection with weak knowledge of this disease doctors quite often diagnose it as Alzheimer's disease as vascular dementia or Parkinson's disease with dementia. This not distinguishing acts as a serious problem not so much in the theoretical plan how many in applied. The patients having dementia with Levi's little bodies show hypersensitivity to the neuroleptics which are usually applied to stopping of psychotic frustration (a hallucination ̆, crazy states) at dementive patients. Development of strong side reactions on neuroleptics can lead patients with dementia with Levi's little bodies to a lethal outcome.
Dementia symptoms with Levi's little bodies:
Dementia with Levi's little bodies is characterized by a number of clinical features ̆.
1. Considerable fluctuations of rasstroistvo (doctors call it fluctuations): disturbances become stronger, again weaken. Small fluctuations can be connected with time of day: expressiveness of rasstroistvo usually increases in the evening when the patient ̆ as if becomes reserved, ceasing to react to an environment. Big fluctuations (of several days ̆ up to several weeks) are connected with influence infectious a disease ̆, with metabolism problems, with injuries, with an exacerbation of chronic diseases ̆. During such periods of the patient ̆ ceases to communicate, experiences difficulties in daily ̆ motive ̆ activities. Big fluctuation usually begins with disturbance ̆ a dream and psychotic rasstroistvo – and is followed by serious violations space ̆ and temporary ̆ orientations, problems with some aspects speech ̆ activity, hallucinations. After the end of fluctuation all functions are partially recovered though the previous level can not be reached.
2. Important feature of dementia with Levi's little bodies at all stages of a disease – dementias of disturbance of concentration of attention which were more expressed in comparison with other types. The attention suffers in bigger ̆ degrees, than, for example, the speech or memory. Attention rasstroistvo that the patient ̆ quickly is tired and easily distracts from the begun business are shown. He is not able to continue long work demanding intellectual tension. The impossibility to concentrate negatively affects ability to plan deistviye and to critically control their result. Having planned the purpose, the patient easily forgets it, switching or to foreign things, or to insignificant details. "Cycling" on the same deistviye and its repeated senseless repetition can result (this deviation in medicine call perseveration ̆).
3. Dementia with Levi's little bodies can be diagnosed on one specific symptom – to visually space rasstroistvo. Bolno ̆ experiences difficulties in recognition of objects (especially in complex combinations and when imposing images), complains of deterioration in sight. Against the background of visual and space rasstroistvo at first visual illusions, and then and visual hallucinations quite often appear. Tipichny ̆ the option of illusion consists that the patient ̆ takes inanimate objects for animated. At the hallucinations which are usually arising in evening and night time, to the patient images of people ̆ – both familiar, and unfamiliar are. In certain cases (quite seldom) visual hallucinations are followed by auditory, olfactory and tactile (tactile) hallucinations.
At early stages of dementia with Levi's little bodies of a hallucination appear no more than at a half of patients; at the same time criticality concerning images remains, their unreality is realized. Together with development of dementia there can be also crazy rasstroistvo (the patient ̆ claims that surrounding people bear it the malice and aim to cause damage or that someone pursues it), however in dalneishy the crazy ideas die away. At late stages of a hallucination arise approximately at 80% of patients, criticality at the same time decreases.
4. Dementia with Levi's little bodies is followed a dviga by the telny rasstroistvo similar to the extrapyramidal disturbances developing at Parkinson's disease. Parkinsonism is shown at the earliest stages of a disease, it is one of the first clinical symptoms which ̆ can draw attention of the patient and his environment. Treat typical disturbances: increase in a muscle tone (specialists speak – rigidity), involuntary trembling (tremor), disturbance of an ustoichivost. One more display of parkinsonism at patients with dementia ̆ with Levi's little bodies – gait change. It is characterized by the shortened step, a shuffling and disturbance of balance at the beginning and completion of the movement, and also when changing its direction. Falling – important ̆ diagnostic ̆ a symptom of dementia with Levi's little bodies, it is caused not only by parkinsonism, but also already noted problems of concentration of attention, and also typical ̆ for patients vegetative ̆ insufficiency, сопровождающейся the lowered pressure.
Treatment of symptoms of parkinsonism at these patients is accompanied by difficulties as the majority of protivoparkinsonichesky drugs causes visual hallucinations in patients.
5. One more early ̆ dementia symptom with Levi's little bodies – disturbances in active ̆ to a dream phase. At the initial stage of a disease of the patient ̆ can suffer from the nightmares differing in the person ̆ a yavstvennost. Under impression from vision ̆ the patient can make the sharp uncontrollable movements fraught with falling from a bed or an injury ̆ the spouse sleeping with him. At the patient the day drowsiness which is replaced by psychomotor excitement at night can be also observed.
It is necessary to know that danger of dementia with Levi's little bodies consists in its transience. The mental rasstroistvo observed on its background progress more in high gear, than at Altsgeimer's disease. Approximately in five years after emergence of the first signs there comes the stage heavy ̆ dementias.
Treatment of dementia with Levi's little bodies:
Unfortunately, now there are no means capable to suspend or at least to slow down distribution of degenerative process at DTL.
The symptomatic pharmacotherapy has to be extremely careful - patients are exclusively sensitive to various pharmacological means: purpose of drug concerning one syndrome can cause deterioration in other syndrome.
Considering key value of cholinergic deficit in genesis of cognitive, psychotic and behavioural disturbances, at DTL purpose of inhibitors of cholinesterase which can positively influence not only on cognitive, but also to psychotic, affective and behavioural disturbances is shown, significantly reduce the need for neuroleptics. Nevertheless inhibitors of cholinesterase cause intolerable side effects in a part of patients (for example, sharp aggravation of orthostatic hypotension, a bradyarrhythmia, nausea, vomiting) or are insufficiently inefficient. In this regard search of alternative ways of treatment of DTL is necessary.