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Demencia de cuerpos de Lewy: síntomas y consecuencias de la enfermedad que llevó a Robin Williams al suicidio Robin Williams en un fotograma de 'El club de los poetas muertos' (1989). Cordon Press.
Puede comenzar con un simple despiste, continuar con un cúmulo de pesadillas que deterioran nuestro sueño y acabar con la muerte neuronal: así se manifiesta esta demencia, la segunda más frecuente después del Alzheimer 50 millones de personas de todo el mundo están afectadas por algún tipo de demencia , según datos de la Oganización Mundial de la Salud. De ellas, alrededor del 60% viven en países de ingresos bajos o medios. Cada año se diagnostican cerca de 10 millones de nuevos casos para los cuales no siempre hay tratamiento. Se calcula que entre un 5 y un 8% de la población de 60 o más años sufre demencia en un momento de su vida . El Alzheimer es posiblemente la demencia más conocida, pero hay otras tan prevalentes como ella. Es el caso de la demencia de cuerpos de Lewy, la que padecía sin saberlo Robin Williams. El actor estadounidense se suicidó en 2014 después de unos meses de sufrimiento en los que llegó a afirmar que "se rompía por dentro".
Entre el olvido y las alucinaciones "La demencia con cuerpos de Lewy produce deterioro cognitivo y es la segunda demencia degenerativa después del Alzheimer ", explica Ángel Martín, neurólogo y vocal del Grupo de Estudio de la Sociedad Española de Neurología. Se caracteriza por una pérdida de memoria, habilidades del lenguaje, percepción visual, capacidad para resolver problemas o tareas cotidianas o incapacidad para prestar atención.
La demencia con cuerpos de Lewy está asociada a la enfermedad de Parkinson. Ambos tipos de demencia causan los mismos cambios en el cerebro y provocan los mismos síntomas . La principal diferencia es cuándo comienzan a manifestarse los síntomas cognitivos y los de movimiento. La demencia con cuerpos de Lewy también comparte manifestaciones con la enfermedad de Alzheimer , pero, además, causa otras disfunciones, como problemas de movilidad, alucinaciones visuales y problemas del sueño.
"La característica principal es la alteración de la atención, de pronto comienza a haber despistes de una manera muy fluctuante . Después, comienzan otros síntomas que pueden vincularse al Parkinson, como temblores, lentitud de movimientos o rigidez corporal", afirma Ángel Martín. La fase más crítica es posiblemente cuando el paciente presenta "alucinaciones visuales, síntomas psicóticos o fallos en el reconocimiento de familiares" , advierte este neurólogo.
¿Cuál es la causa? La demencia con cuerpos de Lewy está causada por la acumulación de este tipo de cuerpos en las partes del cerebro que controlan la memoria, el pensamiento y el movimiento. Los cuerpos de Lewy son depósitos anormalmente grandes de una proteína llamada alfa-sinucleína . No existe aún ninguna evidencia científica que explique por qué se producen estas acumulaciones, pero sí se sabe que el Parkinson está asociado al exceso de la misma proteína.
El mayor factor de riesgo de la demencia con cuerpos de Lewy es la edad. La mayoría de las personas que la desarrolla es mayor de 50 años, pero no existe un componente hereditario. "La causa genética es excepcional, menos aún que en el Alzheimer, que está en torno al 1% . Sí puede hablarse de polimorfismos; es decir, una determinada composición genética que pueda predisponernos, pero no es la causa general", asegura este especialista.
Cambios en el descanso y sueños agitados La demencia con cuerpos de Lewy es una enfermedad progresiva, lo que implica que los síntomas comienzan lentamente y se agravan en el tiempo. Las alteraciones más frecuentes causadas por la enfermedad tienen que ver con el sueño, la cognición, el movimiento y el comportamiento. La enfermedad se manifiesta cuando el paciente pierde funciones mentales que afectan a su vida diaria. No puede concentrarse, cambia con frecuencia de estado de ánimo, sintiéndose triste o apático, y presenta alteraciones del sueño .
"Los cambios en los patrones de sueño es uno de los síntomas que pueden aparecer años antes de que se diagnostique la enfermedad. Nos referimos, en concreto, el trastorno durante la fase REM, con muchos movimientos involuntarios, agitaciones, luchas, incluso hay pacientes que intentan pegar al compañero… El 70% de estos enfermos han presentado este comportamiento antes de desarrollar la enfermedad”, afirma Ángel Martín.
Camuflada con Parkinson y Alzheimer Hasta el momento, no existe una prueba para diagnosticar la demencia con cuerpos de Lewy. Ante los primeros síntomas es necesario contactar con un neurólogo para que realice una historia clínica que incluya el detalle de los síntomas . En esta toma de datos es importante que el paciente esté con sus cuidadores. Más tarde, el especialista realizará exámenes físicos y neurológicos para descartar otras afecciones. En el caso de la demencia con cuerpos de Lewy, a veces se camufla con Parkinson y Alzheimer, dado que comparten síntomas. También es posible que concurran.
Sin cura, pero con tratamiento sintomático: el mejor, la vida social No hay aún cura para esta enfermedad, aunque algunos medicamentos pueden ayudar a controlar algunos de sus síntomas. Es el caso de la rivastigmina, que actúa sobre la acción de la acetilcolina, la sustancia química que actúa en la transmisión de los impulsos nerviosos . En los casos con alucinaciones frecuentes, puede ser necesario la administración de fármacos utilizados en psiquiatría.
Al margen de los recursos médicos, existen terapias que pueden ayudar a paliar los efectos de la enfermedad. Entre ellas, destacan las siguientes:
Fisioterapia para ayudar con problemas de movimiento. Terapia ocupacional puede ayudar a encontrar maneras de hacer más fácilmente las actividades diarias. Terapia del habla para ayudar a expresarse mejor con el lenguaje oral y a solucionar los problemas de deglución. Terapia musical o artística para reducir la ansiedad y mejorar el bienestar Grupos de apoyo (asociaciones, fundaciones, grupos de hospitales o centros de salud, servicios sociales) para ofrecer soporte emocional y social. Además de todos recursos, mantener en buen estado nuestra reserva cognitiva tanto para prevenir como para paliar los efectos de la enfermedad es quizá lo más importante. "La reserva cognitiva es la capacidad del cerebro para compensar cuando se produce algún problema ", señala Ángel Martín. "Cuanto mayor es el nivel educativo, se ha leído más y, en general, hay mayor actividad social, hay menos incidencia de la enfermedad", concluye el neurólogo.
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