Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is a common cause of dementia in older adults. It combines cognitive changes with parkinsonian movement symptoms, visual hallucinations, and marked fluctuations in alertness or attention. Many people also experience REM sleep behaviour disorder and sensitivity to certain medications.

At The Royal Buckinghamshire Hospital, we offer consultant-led inpatient neurorehabilitation. Our programmes focus on safer mobility, cognition and communication support, fatigue and sleep strategies, plus education for families and carers.

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Key Features And Symptoms

• Cognitive fluctuations: variable attention, alertness and “good/bad days”.
• Visual hallucinations: well-formed images (people/animals) that may recur.
• Parkinsonism: slowness, rigidity, reduced arm swing, shuffling gait, falls.
• Sleep disturbance: REM sleep behaviour disorder (acting out dreams).
• Autonomic symptoms: dizziness on standing, constipation, urinary urgency.
• Visuospatial problems: judging distances, navigating, misperceiving objects.
• Medication sensitivity: many patients are very sensitive to antipsychotics.

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How DLB Is Diagnosed

Diagnosis is made by a specialist based on history and examination. Tests may include:

• Cognitive assessment profiling attention, executive and visuospatial skills.
• MRI or CT brain to rule out alternative causes.
• DaTscan (dopamine transporter imaging) in selected cases to support diagnosis.
• Sleep assessment if REM sleep behaviour disorder is suspected.

Medical treatment (e.g., cholinesterase inhibitors, cautious use of dopaminergic therapy, sleep management and autonomic symptom care) is directed by neurology/geriatrics or old-age psychiatry. We work alongside those teams on functional recovery and day-to-day independence.

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Rehabilitation At The Royal Buckinghamshire Hospital

Our inpatient neurorehabilitation programmes are tailored to the mixed cognitive–motor profile of DLB.

What Your Programme May Include

• Neurophysiotherapy: gait cueing and step-length training, balance and postural stability, falls-prevention, safe turning, assistive device optimisation.
• Occupational Therapy: strategies for fluctuations, routine planning, energy conservation, environmental adaptations, seating and transfers, activities of daily living.
• Speech & Language Therapy: communication strategies, cognitive-communication support, swallowing screening and compensatory advice where indicated.
• Neuropsychology: attention and executive strategies, anxiety/low mood support, insight and coping skills, carer education and resilience.
• Sleep & Fatigue Management: REM sleep behaviour safety tips, daytime structure, pacing and rest scheduling.
• Medication Awareness: education around antipsychotic sensitivity and red-flag side effects (in coordination with the prescribing team).
• Discharge Planning: clear home exercise plan, falls plan, and community therapy recommendations.

Explore Our Rehabilitation Centre
Falls And Balance Rehabilitation
Post-Traumatic Fatigue Syndrome

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When To Consider Inpatient Rehab

• Increasing falls or unsafe transfers despite outpatient input.
• Worsening gait freezing, turning difficulty or fear of falling.
• Cognitive fluctuations disrupting daily life, communication or self-care.
• Emerging swallowing or communication difficulties.
• Carer strain or need for co-ordinated multidisciplinary input and education.

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Living Well With DLB

• Keep a structured daily routine with regular rest breaks.
• Use visual and auditory cues for starting steps and turning.
• Optimise lighting and contrast at home to reduce misperception.
• Review home hazards and footwear; consider grab rails and seating.
• Keep a simple medication and appointments diary; share therapy strategies with family/carers.