What are the first signs of a Lewy body?

Early Signs of Dementia with Lewy Bodies

Recognizing the early signs of dementia with Lewy bodies (DLB) can be challenging, but certain symptoms stand out—especially when they appear together. Unlike other forms of dementia, DLB often announces itself through distinct changes that affect both mind and body.

One of the hallmark early signs is visual hallucinations. These aren't fleeting or stress-induced; they're vivid and recurrent, often involving people or animals not actually present. What's striking is that these hallucinations tend to occur early in the disease, sometimes even before memory problems become obvious.

Another key feature is the fluctuation in cognitive function. A person may seem alert and lucid one moment, then confused or disoriented the next. These shifts in attention and awareness can vary throughout the day and are often mistaken for mood swings or medication side effects. Family members might describe it as "tuning in and out" of reality.

Alongside these mental changes, many people develop symptoms of parkinsonism. Slowness of movement, tremors, stiffness, or difficulty with balance and walking can emerge early, sometimes even before cognitive decline is apparent. Unlike Parkinson’s disease, however, DLB patients often don’t respond as well to traditional movement disorder medications.

Sleep disturbances, such as acting out dreams (a condition known as REM sleep behavior disorder), can also precede other symptoms by years. Depression, sensitivity to antipsychotic medications, and autonomic dysfunction—like changes in blood pressure or digestion—are additional clues.

Because DLB shares features with Alzheimer’s and Parkinson’s diseases, it’s often misdiagnosed. Yet catching it early matters—not just for managing symptoms, but for improving quality of life through tailored care. If you or a loved one are experiencing a combination of hallucinations, mental fluctuations, and movement issues, seeking a specialist evaluation is crucial.