Robin williams and Lewy Body Disease

Brainposts: In a post last week, I highlighted a recent study examining clinical issues in the diagnosis of Lewy body dementia (LBD).This study examined differentiating clinical and neuropsychological factors between LBD, Alzheimer's dementia and Parkinson's disease. This topic received significant attention following the description of comedian Robin Williams' last years by his wife in the journal Neurology. Robin Williams suffered from LBD and like many, his diagnosis was not made until autopsy.


I want to review some of the key clinical features shown by Robin Williams described by his widow's in his last few years.

Psychological symptoms/signs

• Anxiety
• Fear 
• Panic attacks
• Depression
• Paranoia
• Delusions
• Suicide

Cognitive symptoms/signs

• Memory impairment
• Fluctuating levels of memory/orientation

Physical symptoms/signs

• Constipation
• Urinary problems
• Heartburn
• Insomnia
• Poor sense of smell
• Sensitivity to anti-psychotic medications
• Tremor left hand
• Freezing of gait

Lab/Imaging

• Elevated serum cortisol levels
• Normal brain imaging (CT or MRI?)

Neuropathology

• 40% loss of dopamine neurons
• Lewy bodies throughout brain
• High concentration of Lewy bodies in brain amygdala

A clinical diagnosis of Parkinson's disease had been made for Robin and he had been placed on anti-Parkinson's medication. 

Signs and symptoms of LBD as outlined by Mayo Clinic staff  include:

• Visual and other hallucinations
• Movement disorder (signs of Parkinson's disease)
• Autonomic nervous system dysregulation (tachycardia, sweating, constipation, dizziness, falls)
• Cognitive problems (confusion, visuospatial problems, memory loss, fluctuating levels of attention)
• Sleep problems (REM sleep behavior problems)
• Depression/Apathy

As noted in Mrs. Williams' description, Robin Williams never reported visual hallucinations, a key symptom in LBD.  However, his clinical team felt is was quite possible visual hallucinations could have been present and simply not disclosed due to fear of how others would perceive the hallucinations.

The high concentration of Lewy bodies in the brain amygdala could explain some of the panic, fear and depression noted in the case history.

Suicide is not commonly noted in LBD although it has not been studied in great detail. I will examine this issue in a separate post.

Mrs. Williams has done a great service in writing this clinical history. She urges increased research into the causes and treatment for LBD. Additionally, her report again underscores the need for clinicians to be vigilant for the signs and symptoms of LBD.

I highly recommend reading about the clinical history of Robin Williams. You can access the free full-text report by clicking HERE.

Access the Mayo Clinic description of Lewy body dementia by clicking HERE.

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