Demencija sa Levijevim telima
Demencija sa Levijevim telima | |
---|---|
Sinonimi | Difuzna bolest Levijevih tela, demencija zbog Levijeve bolesti |
Mikroskopska slika Levijevog tela (vrh strelice) u neuronu supstancije nigre; skala bar=20 mikrona (0,02 mm) | |
Specijalnosti | Neurologija, psihijatrija |
Simptomi | Demencija, abnormalno ponašanje tokom REM spavanja, fluktuacije u budnosti, vizuelne halucinacije, parkinsonizam[1] |
Vreme pojave | Posle 50. godine,[2] medijana 76[3] |
Trajanje | Dugoročno[4] |
Uzroci | Nepoznato[4] |
Dijagnostički metod | Na osnovu simptoma i biomarkera[1] |
Slična oboljenja | Alchajmerova bolest, Parkinsonova demencija, pojedine mentalne bolesti, vaskularna demencija[5] |
Lekovi | Donepezil, rivastigmine i memantin;[6] melatonin[7] |
Prognoza | Promenljiva; prosečno preživljavanje 4 godine od dijagnoze[8] |
Frekvencija | Oko 0,4% osoba starijih od 65[9] |
Demencija sa Levijevim telima (DLB) je tip demencije koju karakterišu promene u snu, ponašanju, spoznaji, kretanju i regulaciji automatskih telesnih funkcija. Gubitak pamćenja nije uvek rani simptom. Bolest se vremenom pogoršava i obično se dijagnozira kada kognitivno oštećenje ometa normalno svakodnevno funkcionisanje. Zajedno sa demencijom Parkinsonove bolesti, DLB je jedna od dve demencije Levijevih tela. To je uobičajen oblik demencije, ali prevalencija nije tačno poznata i mnoge dijagnoze se propuštaju. Bolest je prvi opisao Kenji Kosaka 1976. godine.
Poremećaj ponašanja u REM fazi spavanja (RBD) — u kojem ljudi gube paralizu mišića (atoniju) koja se obično javlja tokom REM spavanja i oponašaju sadržaj svojih snova — ključna je karakteristika. RBD se može pojaviti godinama ili decenijama pre drugih simptoma. Ostale ključne karakteristike su vizuelne halucinacije, izražene fluktuacije u pažnji ili budnosti, i parkinsonizam (sporost kretanja, otežano hodanje ili ukočenost). Pretpostavljena dijagnoza se može postaviti ako je prisutno nekoliko karakteristika bolesti ili biomarkera; dijagnostička obrada može uključivati testove krvi, neuropsihološke testove, snimanje i studije spavanja. Konačna dijagnoza obično zahteva autopsiju.
Većina ljudi sa DLB nema pogođene članove porodice, iako se povremeno DLB vodi u porodici. Tačan uzrok je nepoznat, ali uključuje formiranje abnormalnih nakupina proteina u neuronima u celom mozgu. Manifestujući se kao Levijeva tela (otkrio ih je 1912. Frederik Levi) i Levijevi neuriti, ove nakupine utiču na centralni i na autonomni nervni sistem. Funkcija srca i svaki nivo gastrointestinalne funkcije - od žvakanja do defekacije - mogu biti pogođeni, a zatvor je jedan od najčešćih simptoma. Može se javiti i nizak krvni pritisak pri ustajanju. DLB obično izaziva psihijatrijske simptome, kao što su izmenjeno ponašanje, depresija ili apatija.
DLB obično počinje posle pedesete godine,[2] a ljudi sa bolešću imaju prosečan životni vek, sa velikom varijacijom, oko četiri godine nakon dijagnoze.[8] Ne postoji lek koji bi zaustavio napredovanje bolesti, a ljudi u kasnijim stadijumima DLB-a verovatno neće moći da se brinu o sebi. Tretmani imaju za cilj da ublaže neke od simptoma i smanje teret za negovatelje. Lekovi kao što su donepezil i rivastigmin mogu privremeno poboljšati spoznaju i ukupno funkcionisanje, a melatonin se može koristiti za simptome vezane za spavanje. Antipsihotici se obično izbegavaju, čak i za halucinacije, jer se teške reakcije javljaju kod skoro polovine osoba sa DLB,[10] i njihova upotreba može dovesti do smrti. Upravljanje mnogim od različitih simptomima je izazovno, jer uključuje više specijalnosti i obrazovanje negovatelja.
Reference[uredi | uredi izvor]
- ^ а б McKeith et al. 2017, Table 1, p. 90.
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- ^ Hershey & Coleman-Jackson 2019, стр. 309.
- ^ а б „Dementia with Lewy bodies information page”. National Institute of Neurological Disorders and Stroke. 27. 3. 2019. Архивирано из оригинала 18. 3. 2021. г. Приступљено 18. 3. 2020.
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- ^ Watts et al. 2022, стр. 206.
- ^ Taylor et al. 2020, sec. "Sleep disturbances".
- ^ а б Armstrong 2021, sec. "Progression".
- ^ Levin et al. 2016, стр. 62.
- ^ Taylor et al. 2020, sec. "Neuropsychiatric symptoms".
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Spoljašnje veze[uredi | uredi izvor]
Klasifikacija |
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- McKeith IG (10. 10. 2017). Updated diagnostic criteria and management of Lewy body dementia (Video). ALZForum co-hosted with Lewy Body Dementia Association. Pristupljeno 8. 4. 2018.
- „Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD”. Lewy Body Dementia Association. Pristupljeno 28. 11. 2023. – lists of typical and atypical antipsychotics
- „Emergency room treatment of psychosis”. Lewy Body Dementia Association. septembar 2015. Pristupljeno 27. 4. 2018.
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