Dude Ranch

The spouse comments her husband’s cognitive ability has taken a definite decline since her appointment six months ago. Gesticulating with her hand she shows how she has been shown the process of decline will be; horizontal for some time then a dip to a new horizontal plane. The doctor enlightens the couple the patient is probably the most documented patient he has, who he believes suffers from dementia with Lewy Bodies.

The patient is sturdy. At rest in the chair, he has no spontaneous movement. By his side, his wife types on her laptop while she listens to the doctor who speaks to the patient. He bought a mobile home for ten thousand dollars one day, and drove it home. The contract had no three days qualifying clause, so they could not return it. The wife concedes the children and grandchildren use it occasionally. She estimates it’s used four times a year. Driving has become a sore point, though he has a driver, who takes him where he needs to go. He thinks he may take a driving course, though the doctor discourages him, citing the fact that patient’s with parkinsonian syndromes lack “normal” spatial relations. Studies have shown patients tend to favor one side of the road, listing towards the curb, or the center of the thoroughfare. Whether or not they still retain the ability to shift quickly, they are hazardous to others.

His voice is soft, and the doctor leans across the desk to hear him. He would like to know what he can expect next, with the illness he has. The doctor comments there have been longitudinal studies on patients with parkinson’s disease, but none that he is aware of, of those diagnosed with Lewy body dementia. He speaks about a larger study enrolling people who suffered from dementia. Only seven to eight percent of those were thought to suffer from Lewy Body disease. Alzheimer’s disease is a more common cause of dementia.

None of the parkinsonian medications are useful for his symptoms. The doctor states they would worsen his quality of life by adding to the mental confusion, and tendency to hallucinate. Namenda and Aricept are two medications he takes to forstall mental decline. Vigorous physical exercise might help his condition, if he could motivate himself to do it. His wife agrees diet and exercise can go a long way to alleviating many ills, though she knows her spouse well. He attends silver sneakers, and a yoga class. The doctor encourages his yoga, and commends him for retaining interests he can engage in. Another desire is to ride horses. He has found a place, whether they will allow him on a horse, his wife is not sure.

Excerpt from article comparing DLB and AD

“Although cross-sectional studies have suggested similarities between DLB and AD in overall level of cognitive dysfunction, patients with DLB are reported to have more pronounced executive, attentional, and visuospatial deficits early in the course of the dementia. Several studies suggest that patients with DLB perform better than patients with AD on verbal recall tasks, but others have found no differences. Patients with DLB may have more difficulty with the free recall of declarative information in the context of relatively intact recognition memory. There have been fewer studies comparing progression of cognition in DLB and AD, and their results have been somewhat equivocal. In 3 studies, the rate of decline in global cognitive function was similar in AD and DLB Another noted faster decline in DLB. With regard to everyday functioning, 1 retrospective study found that patients with DLB were more likely to be institutionalized than patients with AD. However, both groups displayed a similar time to reaching an end point of moderate to severe functional impairment, as measured by the Blessed Dementia Rating Scale (BDRS).”

Karina Stavitsky, BS; Adam M. Brickman, PhD; Nikolaos Scarmeas, MD; Rebecca L. Torgan, BS; Ming-Xin Tang, PhD; Marilyn Albert, PhD; Jason Brandt, PhD; Deborah Blacker, MD; Yaakov Stern, PhD The Progression of Cognition, Psychiatric Symptoms, and Functional Abilities in Dementia With Lewy Bodies and Alzheimer Disease. Arch. of Neur. Oct. 2006, Vol 63, No. 10

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