Denavir
Denavir
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CHRONIC CONFUSION: CORTICAL LEWY BODY DISEASE
It has been recognized for many years that people with Parkinson’s disease may go on to develop a chronic confusional state. There was much debate as to whether this was the same person also developing Alzheimer’s disease or a different condition. The breakthrough has come with better scientific techniques for looking at brain tissue under the microscope. The cause of Parkinson’s disease appears to be a fall in the amount of a chemical (dopamine) produced, needed to produce normal movement, and the appearance of tiny pieces of protein within the dying brain cell – the Lewy body. Lewy bodies have until recently only been found in the same area as the dopamine producing cells, the brain stem. They are thought to be made up of various pieces of the cells’ workings coming together as the cell dies.
New staining techniques have now shown these Lewy bodies to be present in the main part of the brain, the cortex (where our memory and thinking processes occur), in those patients with the confusion associated with Parkinson’s disease. Researchers in the held have called this form of chronic confusion Cortical Lewy Body disease. It appears that the disease can start as Parkinson’s disease and develop into the dementia or it may start as a chronic confusional state (dementia) with Parkinsonian features developing later.
It is definitely separate from Alzheimer’s disease but has some similar features. It is also thought to be very common and some researchers think it is the most common dementia after Alzheimer’s disease, accounting for about 15 per cent of total cases of dementia. The dementia affects memory, language, praxis (complicated actions), gnosis (recognition of what things are) just the same as in Alzheimer’s disease. There do appear to be some differences however. The cognitive impairment (all the brain functions such as memory) has a fluctuating course which does not happen in Alzheimer’s disease. There are some prominent features including a marked tendency to visual and auditory hallucinations, delusions (believing a particular false idea is correct) and some aggression and depression.
This new condition may have far reaching consequences for the diagnosis of chronic confusional states. Many people with a diagnosis of Alzheimer’s disease go on to develop features of Parkinson’s disease. These include stiffness and some tremor. This has been put down to Parkinsonism (features of Parkinson’s disease, but not all of them and hence not the true disease). It may well be that we will need to re-evaluate these people and consider the diagnosis of Cortical Lewy Body disease.
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