Complications
Dysphagia of liquids and solids may increase risk of aspiration pneumonia. Recurrent pneumonia often characterises the terminal stages of DLB and is often the cause of death.
Loss of independence, isolation, and depression may co-exist with physical complications such as bed sores and muscle contractures.
Dysphagia is multi-factorial in DLB, and is related to parkinsonism, behavioural and autonomic symptoms, and cognitive state. It may involve liquids and/or solids. Careful attention to choking symptoms or delayed swallowing is warranted. Percutaneous endoscopic gastrostomy tubes have been shown to provide no benefit in terms of survival, quality of life, or reduced risk of aspiration pneumonia.[77]
Urinary incontinence may require use of a urinary catheter, which is known to increase the risk of urinary tract infections (UTIs). UTIs are a common cause of acute confusional states (delirium). Untreated UTIs can lead to more serious, life-threatening complications, including sepsis and multi-organ failure.
Disorientation, apraxia, and impaired mobility all increase risk of falls. Polypharmacy may contribute to orthostatic hypotension and confusion. Complications of falls include fractures, head injury, and prolonged immobilisation (which can lead to further life-threatening complications such as thromboembolism).
Carer burden, isolation, neglect, limited resources, and ageist attitudes all contribute to this phenomenon. Financial motives may also complicate end-of-life decisions and legal arrangements.
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