Core symptoms of dementia with Lewy bodies

Core symptoms of dementia with Lewy bodies include fluctuating cognitive impairment, recurrent visual hallucinations, parkinsonian motor symptoms, rapid eye movement (REM) sleep behavior disorder, and deficits in attention and executive function. If family members notice these symptoms in elderly individuals, they should promptly seek evaluation and diagnosis at a neurology department.

1. Fluctuating cognitive impairment: This is a characteristic core symptom. Patients experience varying levels of cognitive function (such as memory and attention)—for example, being mentally clear in the morning but suddenly developing confusion and slowed responses in the afternoon. These fluctuations typically last for several hours to days and are often mistaken for normal aging.

2. Recurrent visual hallucinations: These commonly appear early in the disease. Patients frequently see people, animals, or objects that are not present. The hallucinations are often vivid and detailed, and some patients may interact with the hallucinated content. As the disease progresses, hallucinations become more frequent and may be accompanied by other sensory hallucinations (e.g., auditory hallucinations).

3. Parkinsonian motor symptoms: These include limb tremors (often resting tremors), muscle rigidity, bradykinesia (slowness of movement), gait instability, and difficulty turning while walking. These motor symptoms usually appear after cognitive decline and show poor response to medications typically used for Parkinson’s disease.

4. Rapid eye movement (REM) sleep behavior disorder: During sleep, patients may exhibit abnormal behaviors such as kicking, punching, or shouting, often acting out dreams. This can lead to injuries to themselves or their bed partners. This symptom may appear years before other core symptoms emerge.

5. Impairment of attention and executive function: Patients have difficulty concentrating to complete daily tasks (e.g., cooking, shopping). Executive functions—such as planning, decision-making, and problem-solving—are significantly impaired, making it hard to manage daily life independently. Even simple tasks may require assistance from others.

In daily care, it is important to create a safe and familiar living environment for the patient, avoid frequent changes in room layout, assist with daily activities, maintain regular sleep-wake cycles to reduce cognitive fluctuations, closely monitor hallucinations and sleep disturbances, ensure medication is taken as prescribed, schedule regular follow-up visits, and provide the patient with ample patience and companionship.