“The collapse of the Twin Towers created massive dust clouds that filled the air and left hundreds of highly populated city blocks covered with ash, debris, and harmful particles.  In Lower Manhattan, the plane crashes—which resulted in the collapse of the Twin Towers—created massive dust clouds that filled the air and left hundreds of highly populated city blocks covered with ash, debris, and harmful particles, including asbestos, silica, metals, concrete, and glass. Fires within the debris pile and the collapse of 7 WTC burned through the end of December 2001 with continued flare-ups in 2002, releasing carcinogenic combustion by-products. These contaminants remained in Lower Manhattan and parts of Brooklyn for an undetermined amount of time after 9/11. Responders, local workers, residents, students, and others had potential for acute exposures in the early days and continuing exposure from residual materials—indoors and outside—as well as exposure to toxic gases, smoke, vapors, and combustion by-products from continuing fires. ”

Centers for Disease Control & Prevention (https://www.cdc.gov/wtc/exhibition/toxins-and-health-impacts.html)

“Lewy body dementia (LBD) is a type of dementia in which Lewy bodies are present in your brain. Lewy bodies are clumps of proteins that build up inside certain neurons (brain cells). They cause damage to neurons in the areas of your brain that affect mental capabilities, behavior, movement and sleep.  Lewy body dementia is a progressive disease, meaning symptoms start slowly and get worse over time.

In people over the age of 65, LBD is one of the most common causes of dementia. The symptoms of LBD may closely resemble those of other neurological conditions, including Alzheimer’s disease and Parkinson’s disease.”.

Cleveland Clinic  (https://my.clevelandclinic.org/health/diseases/17815-lewy-body-dementia)

Behavioral problems are among the main reasons why dementia patients are placed in long term care facilities. Agitation with non-acute psychosis. Risperidone (FDA warning about cerebrovascular events) Olanzapine (Use with caution in diabetics) Quetiapine (Useful for patients with Parkinsonian symptoms) Ariprazole. Acute agitation. Haloperidol. Sleep disturbances. Melatonin, Trazodone, non-benzodiazepine hypnotics. Avoid antipsychotics in patients with Lewy body dementia. Ref: Charles D. Motsinger. Use of atypical antipsychotic drugs in patients with dementia. Am Fam Physician Jun 1;67(11): Ref: A. deLonghe. Effectiveness of melatonin treatment on circadian rhythm disturbances. Int J Ger Psychiatry 2010; 25:

Unfortunately at this present time there is NO cure or definitive treatment for Lewy Body Bementia. The disease has an average duration of 5 to 7 years. It is possible, though, for the time span to be anywhere from 2 to 20 years, depending on several factors, including the person’s overall health, age and severity of symptoms.  REMEMBER there is an approach in treating the symptoms.

LBD is a multi-system disease and typically requires a comprehensive treatment approach, meaning a team of physicians from different specialties, who collaborate to provide optimum treatment of each symptom without worsening other LBD symptoms.  It is important to remember that some people with LBD are extremely sensitive or may react negatively to certain medications used to treat Alzheimer’s or Parkinson’s in addition to certain over-the-counter medications just like other patients can do with with the meds they take for other diseases.   All meds have side effects.

Cognitive Symptoms

Medications called cholinesterase inhibitors are considered the standard treatment for cognitive symptoms in LBD. These medications were developed to treat Alzheimer’s disease. However, some researchers believe that people with LBD may be even more responsive to these types of medications than those with Alzheimer’s.  Remember Alzheimer’s disease are very similar to LBD symptoms.

Movement Symptoms

Movement symptoms may be treated with a Parkinson’s medication called levodopa, but if the symptoms are mild, it may be best to not treat them in order to avoid potential medication side-effects.  Many are also diagnosed with Parkinson’s disease before being diagnosed with this Dx LBD.

Visual Hallucinations

If hallucinations are disruptive or upsetting, your physician may recommend a cautious trial of a newer antipsychotic medication. (Please see WARNING below.  Of note, the dementia medications called cholinesterase inhibitors have also been shown to be effective in treating hallucinations and other psychiatric symptoms of LBD.

REM Sleep Behavior Disorder (RBD)

RBD can be quite responsive to treatment, so your physician may recommend a medication like melatonin and/or clonazepam.

Neuroleptic Sensitivity

Severe sensitivity to neuroleptics is common in LBD. Neuroleptics, also known as antipsychotics, are medications used to treat hallucinations or other serious mental disorders. While traditional antipsychotic medications (e.g. haloperidol) are commonly prescribed for individuals with Alzheimer’s with disruptive behavior, these medications can affect the brain of an individual with LBD differently, sometimes causing severe side effects (see below). For this reason, traditional antipsychotic medications like haloperidol should be avoided. Some newer ‘atypical’ antipsychotic medications like risperidone may also be problematic for someone with LBD. Quetiapine is preferred by some LBD experts. If quetiapine is not tolerated or is not helpful, clozapine should be considered, but requires ongoing blood tests to assure a rare but serious blood condition does not develop. Hallucinations must be treated very conservatively, using the lowest doses possible under careful observation for side effects.

WARNING:

Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome (NMS), which can be fatal. (NMS causes severe fever, muscle rigidity and breakdown that can lead to kidney failure.)

Medication Side Effects

Speak with your doctor about possible side effects. The following drugs may cause sedation, motor impairment or confusion:

• Benzodiazepines, tranquilizers like diazepam and lorazepam
• Anticholinergics (antispasmodics), such as oxybutynin and glycopyrrolate
• Some surgical anesthetics
• Older antidepressants
• Certain over-the-counter medications, including diphenhydramine and dimenhydrinate.
• Some medications, like anticholinergics, amantadine and dopamine agonists, which help relieve parkinsonian symptoms, might increase confusion, delusions or hallucinations.

NOTE: Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD. People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.

Possible alternatives to general anesthesia include a spinal or regional block. These methods are less likely to result in postoperative confusion. If you are told to stop taking all medications prior to surgery, consult with your doctor to develop a plan for careful withdrawal but suggested as the last resort.

Non-Medical Treatments

Physical therapy options include cardiovascular, strengthening, and flexibility exercises, as well as gait training. Physicians may also recommend general physical fitness programs such as aerobic, strengthening, or water exercise.

Speech therapy may be helpful for low voice volume and poor enunciation. Speech therapy may also improve muscular strength and swallowing difficulties.

Occupational therapy may help maintain skills and promote function and independence. In addition to these forms of therapy and treatment, music and aroma therapy can also reduce anxiety and improve mood.

Individual and family psychotherapy can be useful for learning strategies to manage emotional and behavioral symptoms and to help make plans that address individual and family concerns about the future.

Support groups may be helpful for caregivers and persons with LBD to identify practical solutions to day-to-day frustrations, and to obtain emotional support from others.

End-of-Life

Planning for the end of life can be challenging and hard but a valuable activity for any family.  For some general guidance and some specific suggestions for families who face the burden of a disease such as Lewy body dementia.

Advanced Directives – a Caring Connections site with state-specific advanced directives can be helpful in having measures answered before weeks to days to hours before last minute decisions in medical care have to be made.

Caring Connections – home page of consumer Web site about hospice and palliative care managed by the National Hospice and Palliative Care Organization  This helps with weeks to days before pt moving on to the next world but in the most comfortable way possible.

President Ronald Reagan

“Lewy bodies are clumps of abnormal protein particles that, for reasons that are not fully understood, accumulate in the brain. These deposits cause a form of dementia called Lewy body dementia, or LBD — which is what the late actor and comedian Robin Williams suffered from.

LBD is not the same as Parkinson’s, but the two are closely related: LBD causes some or all of the motor symptoms of Parkinson’s. More than 1 million people in the U.S. are affected by Lewy body dementia, according to the Lewy Body Dementia Association.”

John Hopkins Medicine

“Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimer’s disease. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).  Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention.”

MAYO CLINIC

“Suicide is the second leading cause of death among young adults and for every youth suicide it is estimated that 100 to 200 others attempt suicide. Young adulthood is a time when many people experience significant stress from life transitions such as gaining more independence and responsibility when moving from home and beginning college or a career. That stress has been amplified by the COVID-19 pandemic. Yet, we’ve seen striking glimmers of resilience – the ability to bounce back from a negative experience or difficult challenge. ”

JED Foundation

Depression Vs. Anger — What does it all mean and What do I do?

Getting the blues  or down in the dumps now and than in one thing but staying in the blues or down in the dumps just sinking deeper over a long period of time can be diagnosed as clinical depression. Clinical depression presents many forms and symptoms. It is not something just to be brushed off, assuming it will rectify itself in a while. One of the most common symptoms noted when a person suffers from clinical depression is anger. Whether it’s uncontrollable anger toward oneself or outward aggression toward others, it’s clinically proven that depression and anger run hand in hand.

Do you find yourself feeling angry more often than usual, or more often than not, depression could be to blame. Anger is a common symptom of depression, which can lurk beneath the surface of any man, woman, or child as well.

Depressive disorders come in many different types, but each type has its own unique symptoms and treatments. Major depression, the most common type of a depressive disorder, is characterized by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Mental health professionals use this checklist of specific symptoms to determine whether major depression exists or not. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Severe depression is the most serious type. A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives. Another type of depression is experienced as a part of bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees

Risk Factors

Numerous risk factors can lead to feelings of depression and anger in an individual. Some of these risk factors include but are not limited to: loneliness, financial strain, unemployment, alcohol or drug abuse, marital or family problems, or lack of a social support network. Depression and anger can also be influenced by childhood trauma, or it can be hereditary.

Symptoms

Anger manifested with depression is no ordinary anger. It can be all-consuming feelings of anger and hatred against one’s self, others or the situation that is causing the depression. One of the first signs of depression in a teenager may be a sudden onset of uncontrollable anger. In turn, constant feelings of anger can also trigger a response of depression. Also noted with depression are a tendency to turn away from family and friends, poor performance at work or school, lack of motivation, feelings of guilt, insomnia and hopelessness

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic painMania
• Symptoms of Mania (for Bipolar Disorder)

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

Come back tomorrow for Part 2 on Depression Vs. Anger in Considerations/Treatment and Knowing the Key Factor in what makes us deal with depression, which also can help prevent suicide!!