A Three-Minute Test Diagnoses Lewy Body Dementia

Lewy Body Dementia (LBD) is a neurological condition that affects an estimated 1.4 million people in the U.S. alone, but very few people have ever heard of it. Even clinicians struggle to diagnose it because it overlaps with many other similar disorders such as Parkinson's and Alzheimer's—in fact, 80 percent of LBD cases are misdiagnosed as Alzheimer’s—and psychiatric conditions like schizophrenia. Before his death, actor Robin Williams had been diagnosed with Parkinson's, but an autopsy found "diffuse Lewy body dementia" in his brain. Now clinicians have a way to diagnose the disease. 

Technically, Lewy bodies are abnormal proteins called alpha-synuclein, but they're better known by their eponymous name; Dr. Friederich Lewy, a German neurologist, discovered them in 1912. When they accumulate in neurons, they disrupt brain function, causing cognitive decline, Parkinson’s-like tremors and motor problems, and memory problems. 

Since there are no identified biomarkers to easily diagnose LBD, Dr. James E. Galvin, a professor and associate dean for clinical research at the Charles E. Schmidt College of Medicine at Florida Atlantic University, has created a 3-minute test called the Lewy Body Composite Risk Scale (LBCRS), comprised of 10 questions [PDF], to which a patient must only get three “yes” answers to qualify as having LBD. The test is meant to be administered in a doctor's office. 

In a test-run of its accuracy in a real-world clinic setting, with 256 patients representing a "mixture of gender, education, comorbidities, behavioral, affective, motor symptoms, and diagnoses," the LBCRS was able to discriminate between Alzheimer's disease and LBD with 96.8 percent accuracy. These results were recently published in the journal Alzheimer's & Dementia

“In the absence of a biomarker, you need a tool that can capture these symptoms and frame them in a way that every clinician can ask every patient the same questions and either rule it out, or make the diagnosis likely,” Galvin says.

Diagnosis of LBD is difficult because some symptoms are hard to quantify. “For instance, one of the core features of LBD is cognitive fluctuations, but there is no well-agreed upon definition of these," Galvin explains. "The general consensus is that cognitive fluctuation is a spontaneous change in level of attention, alertness, or focus that can vary from minute to minute, hour to hour. So how do you capture that symptom?”

To make matters more complicated, Lewy bodies are found in many parts of the body, which can cause symptoms that masquerade as other conditions: “You’ll find [Lewy bodies] in the peripheral nervous system, the walls of the gut, the heart, in salivary glands, in sebaceous glands and more,” Galvin says. “Because of this, some of the early symptoms include chronic constipation, heart arrhythmias, changes in salivary glands—drooling—and even dermatitis.”

Though it’s often misdiagnosed as Alzheimer’s due to the shared decline in memory, there are some significant memory differences between the two illnesses. “Alzheimer’s patients have difficulty learning new information, whereas non Alzheimer’s-dementias, including LBD, are better able to learn information but have difficulty retrieving information,” Galvin says. 

LBD patients also have more visual-perceptual problems. “Many of these patients first go to an eye doctor because they think something is wrong with their glasses.”

Though there is not yet a cure for LBD, early diagnosis is helpful for patients, not the least because it can ease the strain that uncertainty puts on families. “[Not having a diagnosis] creates a sense of isolation when no one can explain what’s going on,” Galvin says. 

Early diagnosis is also crucial when it comes to treating symptoms with medications. To treat the various symptoms that occur with LBD, Galvin says, “we borrow medications from other fields. We use Alzheimer’s meds and Parkinson’s meds, and meds from the psychiatric field and the cardiology field.” 

Without a diagnosis of LBD, undiagnosed individuals are at risk for a dangerous condition resulting from neuroleptic medicines—antipsychotics—which are prescribed for hallucinations or schizophrenia-like symptoms. That's because they affect the brains of people with LBD differently, Galvin says: “LBD patients have a tenfold increased risk of getting neuroleptic malignant syndrome, which is characterized by high fever, muscle breakdown, kidney failure, and even death.” The earlier the diagnosis, the less chance of this happening.

Because the Lewy Body Composite Risk Scale is so new, it's not in use much yet. But Galvin is hopeful that eventually his test will help millions of people with the disease get a diagnosis and some form of symptom treatment. He stresses the need for greater awareness of the disease—and more research dollars to study it.

What Is the Difference Between Heat Exhaustion and Heatstroke

YuriS/iStock via Getty Images
YuriS/iStock via Getty Images

When temperatures begin to climb, many of us can find ourselves growing physically uncomfortable. Indoors or out, warm weather can make us lethargic, sweaty, and nostalgic for winter. There are differences, though, between heat exhaustion—a precursor to more serious symptoms—and heatstroke. So what are they? And how can you treat them?

Heat exhaustion happens when the body begins to overheat as a result of exposure to excessive temperatures or high humidity. (Humidity affects the body's ability to cool off, because sweat cannot evaporate as easily in humid weather.) Sufferers may sweat profusely, feel lightheaded or dizzy, and have a weak or rapid pulse. Skin may become cool and moist. Nausea and headache are also common. With heat exhaustion, it’s necessary to move to a cooler place and drink plenty of fluids, though medical attention is not often required.

If those steps aren't taken, though, heatstroke can set in. This is much more serious and involves the body reaching a dangerous core temperature of 104°F or higher. People experiencing heatstroke may appear disoriented or confused, with flushed skin and rapid breathing. They may also lose consciousness. While heat exhaustion can be treated and monitored at home until symptoms resolve, heatstroke is a medical emergency that requires prompt attention by a health professional. Until help arrives, heatstroke should be treated with cool cloths or a bath, but sufferers should not be given anything to drink.

Although young children and those over the age of 65 are most susceptible to heat-related health issues, anyone can find themselves having a reaction to warm temperatures. If you’re outside, it’s best to drink plenty of fluids, wear light-fitting clothing, and avoid being out in the afternoons when it’s warmest. Because sunburn can compromise the body’s ability to cool itself, wearing sunscreen is also a good idea.

While it’s not always possible to avoid hot or humid weather, monitoring your body for symptoms and returning to a cool space out of the sun when necessary is the best way to stay healthy. If you have older relatives who live alone, it’s also a good idea to check on them when temperatures rise to make sure they’re doing well.

[h/t WWMT]

The Long Stride of Tony Little, Infomercial Titan

Mike Coppola, Getty Images for MTV
Mike Coppola, Getty Images for MTV

Tony Little didn’t see it coming. It was 1983, and the aspiring bodybuilder and future Gazelle pitchman was living in Tampa Bay, Florida, winding down his training for the Mr. America competition that was coming up in just six weeks. While driving to the gym, Little stopped at a red light and waited. Suddenly, a school bus materialized on his left, plowing into Little's vehicle and crumpling his driver’s side door.

Dazed and running on adrenaline, Little got out and sprinted over to find the bus was full of children. After seeing that none of the kids were seriously hurt, he promptly passed out. When Little later awoke, he was in the hospital, where he was handed a laundry list of the injuries he had sustained. There were two herniated discs, a cracked vertebrae, a torn rotator cuff, and a dislocated knee. He struggled to maintain his physique in the weight room and made only a perfunctory appearance at that year's Mr. America competition. Little's dreams of becoming a professional bodybuilder had been derailed courtesy of an errant school bus, whose driver had been drunk.

Though it took some time, Little eventually overcame the setback, pivoting from his original goal of being a champion bodybuilder to becoming one of the most recognizable pitchmen in the history of televised advertising. Before he did that, however, he would have to recover from another car accident.

 

For someone so devoted to physical achievement, Little was constantly being undercut by obstacles. During a high school football game, Little—who was a star player on his team in Ohio—ended up tearing the cartilage in his knee after he collided with future NFL player Rob Lytle. From that point on, Little's knee popped out of place whenever he stepped onto the field or went to gym class.

Tony Little is photographed at the premiere of Vh1's 'Celebrity Paranormal Project' in Hollywood, California in 2006
John M. Heller, Getty Images

In There’s Always a Way, his 2009 autobiography, Little wrote about how that injury—and the loss of a potential athletic scholarship—caused him to act out. A friend of his stole a Firebird and took Little for a joyride. When they were caught, Little took the blame; as he was under 18, Little figured he would get by with a slap on the wrist, while his older friend might be tried and convicted of a serious crime as an adult. According to Little, the judge gave him a pass on the condition that he relocate to Tampa Bay, where he could live with his uncle and put some distance between himself and the negative influences in his life. Little agreed.

Because of his previous injury, Little was unable to play football after making the move to Florida; instead, he devoted himself to his new high school’s weight room, where a bad knee was not nearly as limiting. After graduating, he pursued bodybuilding, earning the titles of Junior Mr. America and Mr. Florida. Little envisioned a future where he would be a fitness personality, selling his own line of supplements when he wasn't competing professionally.

The school bus changed all that. Little, who was now unable to train at the level such serious competition required, retreated to his condo, where he said he relied on painkillers to numb the physical and emotional pain of the accident. More misfortune followed: Little accidentally sat in a pool of chemicals at a friend’s manufacturing plant, suffering burns. He also had a bout with meningitis.

While Little was convalescing from this string of ailments and accidents, he saw Jane Fonda on television, trumpeting her line of workout videos. Little was intrigued: Maybe he didn’t need to have bodybuilding credentials to reach a wider audience. Maybe his enthusiastic approach to motivating people would be enough.

By now it was the mid-1980s, and a very good time to get into televised pitching. In 1984, President Ronald Reagan signed the Cable Communications Policy Act, which deregulated paid airtime for cable networks. Herbalife was the first to sign up, airing an infomercial for their line of nutritional products. Soon, stations were broadcasting all kinds of paid programs. Exercise advice and equipment pitches were abundant, a kind of throwback to department stores that used to feature product demonstrations. It was not enough to read about a Soloflex, which used resistance bands to strengthen muscles. It was better to see it in action.

Now that he was back in shape, Little was ready to make his mark. He was told by his local cable access channel that he could buy 15 half-hours of airtime for $5500. To raise the money, Little started a cleaning service for gyms and health clubs. After airing installments of an exercise program, he was picked up by the Home Shopping Network (HSN). Little made his HSN debut in 1987. With his energetic pitch and trademark ponytail, he sold 400 workout videos in four hours.

 

Little was on the home-shopping and infomercial circuit for years before landing his breakthrough project. In 1996, the Ohio-based company Fitness Quest was preparing to launch their Gazelle, an elliptical trainer that could raise the heart rate without any impact on joints. People used their hands and feet to move in a long stride that felt effortless.

Little felt he would be the perfect spokesperson for the Gazelle and entered into an arrangement with Bob Schnabel, the company's president. The night before the infomercial was scheduled to shoot, Little was driving when he got into another serious car accident that required 200 stitches in his face. Little called Schnabel to break the news, and was told he’d have to be replaced.

Tony Little demonstrates a Gazelle during an MTV upfront presentation in New York in 2016
Mike Coppola, Getty Images for MTV

Undaunted, Little flew from Florida to Ohio to speak to Schnabel in person. By insisting that he could make the story inspirational (and that he could cover up his injuries with make-up), Little managed to convince Schnabel to proceed with the infomercial as planned. The Gazelle ended up with $1.5 billion in revenue, with Little’s other ventures—Cheeks sandals, bison meat, and a therapeutic pillow—bringing the total sales of his endorsed products to more than $3 billion. Little later reprised his Gazelle pitch for a Geico commercial, which also served as a stealth ad for the machine—which is still on the market.

While pitching wound up being relatively low-impact, it was not completely without problems. Little once said that the accumulation of appearances—more than 10,000 in all—has done some damage to his neck because of constantly having to swivel his head between the camera and the model demonstrating his product.

Those appearances have made Little synonymous with the machine. In 2013, the Smithsonian's National Zoo wondered what to name their new baby gazelle. The answer: Little Tony.

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