When Dementia Is Not What It First Appears: Understanding Lewy Body Dementia

Author’s Note / Trigger Warning:
The following article discusses neurodegenerative disease, cognitive decline, hallucinations, and loss of independence. This content may be difficult for some readers.

Disease is often an unseen cruelty. Cancer takes bodies. Influenza can take lives. Dementia, however, takes something different. It slowly erodes memory, identity, and recognition. Loved ones fade into unfamiliar versions of themselves. Confusion, agitation, and sorrow become constant companions—not only for the person affected, but for those who love them.

Among the many forms of dementia, Lewy Body Dementia (LBD) is particularly devastating and frequently misunderstood.

According to the Lewy Body Dementia Association, LBD affects an estimated 1.3–1.4 million people in the United States, making it the second most common form of degenerative dementia after Alzheimer’s disease. Yet despite its prevalence, it is often misdiagnosed or recognized too late.

What Is Lewy Body Dementia?

Lewy Body Dementia is caused by the accumulation of abnormal protein deposits—Lewy bodies—inside brain cells. These deposits disrupt communication between neurons and affect multiple systems simultaneously, including:

• Thinking and attention

• Memory

• Movement (parkinsonian symptoms)

• Sleep

• Behavior and perception

Because LBD impacts both cognitive and motor systems, it often overlaps clinically with Alzheimer’s disease and Parkinson’s disease, contributing to frequent misdiagnosis.

Common symptoms include fluctuating cognition, visual hallucinations, REM sleep behavior disorder, spontaneous parkinsonism, repeated falls, and pronounced sensitivity to certain medications—particularly antipsychotics.

A Case Illustration: Jim

Jim was a 68‑year‑old semi‑retired university professor. He was intelligent, quirky, and socially engaging. Over time, subtle changes began to appear.

He became increasingly prone to falls at home. Because Jim occasionally drank alcohol, these incidents were initially dismissed. His wife later discovered impulsive spending on multiple streaming services he could not recall signing up for. He developed unusual nervous movements consistent with parkinsonian symptoms. His speech, once hyperlexic and articulate, became disorganized. His body language no longer matched his words. His posture and gait changed.

Eventually, Jim became hostile, paranoid, and erratic. He reported seeing “angels” and speaking with his deceased brother. At first, clinicians suspected alcohol‑induced psychosis or a primary psychiatric disorder.

It was not until a hospital admission and neurological evaluation that the words “Lewy Body Dementia” were spoken—words that irrevocably altered his wife’s life.

Why Accurate Diagnosis Matters

Lewy Body Dementia is frequently misdiagnosed as Alzheimer’s disease, Parkinson’s disease, or late‑life psychosis. Studies suggest that nearly 80% of individuals with LBD receive an initial incorrect diagnosis, often after years of symptoms.

This misdiagnosis is not benign.

People with LBD are exquisitely sensitive to antipsychotic medications, particularly first‑generation agents such as haloperidol (Haldol). Up to 50% of individuals with LBD may experience severe neuroleptic sensitivity reactions, including rapid cognitive decline, profound sedation, worsening parkinsonism, and potentially fatal neuroleptic malignant syndrome.

In Jim’s case, the administration of haloperidol dramatically worsened his condition—ironically confirming the diagnosis of LBD.

Due to the severity of his symptoms, Jim was unable to return home and now resides in a memory care facility within driving distance of his family.

When Memory Care Is Not Yet Required

Not everyone with Lewy Body Dementia requires immediate placement in memory care. Some individuals retain partial independence and can remain at home with appropriate supports.

Helpful strategies include:

• Avoiding over‑the‑counter sleep aids and anticholinergic medications that impair cognition

• Reducing clutter and establishing predictable routines for activities of daily living

• Minimizing environmental noise and distractions

• Avoiding “quizzing” or testing memory

• Creating financial safeguards to prevent impulsive spending

• Using calm, clear, and non‑judgmental communication

Support should be adaptive, respectful, and grounded in safety rather than correction.

If You Suspect Lewy Body Dementia

Early recognition can reduce harm and improve quality of life. If you suspect LBD, consult with a neurologist or healthcare provider familiar with this condition.

The Lewy Body Dementia Association provides a comprehensive symptom checklist for patients, caregivers, and clinicians:

👉 Lewy Body Dementia Symptom Checklist (PDF)

Final Thoughts

Lewy Body Dementia is not merely a memory disorder—it is a complex, systemic neurodegenerative disease that demands awareness, accurate diagnosis, and compassionate care. For caregivers and families, the journey is often isolating and overwhelming. For patients, the experience can be terrifying.

Knowledge does not erase grief—but it can prevent unnecessary suffering.

References

1. Lewy Body Dementia Association. (2023). Diagnosing Lewy body dementia is tricky but vital.

2. BMJ Best Practice. (2025). Dementia with Lewy bodies: Symptoms, diagnosis and treatment.

3. Lewy Body Dementia Association. (2026). LBD medical alert wallet card and medication warnings.

4. Dementia Trainer. (2025). Sensitivity to antipsychotic medications in Lewy body dementia.

5. Frontiers in Psychiatry. (2025). Case report: Lewy body dementia with antipsychotic sensitivity.

Navigating Grief Together: A Message from Dr. Courtney Stivers

Over the past two weeks, our workplace community has been touched by a profound wave of loss. Three of our employees have experienced the passing of close loved ones, and within my own extended family, we are mourning the loss of a child to cancer. These moments remind us of the fragility of life, the depth of human love, and the universal experience of grief that connects us all.

Grief is not a linear journey, nor is it something that follows rules or timelines. It arrives without warning, lingers in unexpected ways, and reshapes our understanding of the world. For some, it shows up as tears. For others, silence. For many, it appears as exhaustion, confusion, or even moments of laughter that bring guilt. All these experiences are real, valid, and deeply human.

The Weight We Carry

When loss touches a workplace, it doesn’t stay at the door. We bring our whole selves to our work—our strengths, our fears, our hopes, and our heartaches. As we navigate these recent losses, it's important to recognize that grief affects each of us differently. There is no “right way” to mourn. What matters is that no one faces it alone.

To everyone else who wants to help: your compassion and patience can be a powerful source of comfort. Sometimes the smallest gestures—checking in, offering help, or simply acknowledging someone’s pain—can mean more than you realize.

When Grief Hits Close to Home

As I walk through grief within my own family, I am reminded of both the pain and the privilege of being human. Losing a child—especially to something as senseless as cancer—is a wound that words cannot fully hold. My family is learning, day by day, how to breathe differently, love differently, and find meaning again in the midst of heartbreak.

Sharing this with you is not easy, but it feels important. Leaders are not immune to loss. Professionals do not cease to be vulnerable. And even those who help others through their darkest moments must also learn to walk through their own.

Years ago, I endured the painful loss of my mother after her battle with an aggressive from of breast cancer. Losing a parent leaves a particular kind of void—one filled with memories, gratitude, and the ache of unfinished conversations.

During that time, my family was lifted by tremendous support from friends, loved ones, and our community. Their meals, prayers, messages, and simple presence reminded us that even in the darkest seasons, we do not walk alone. That support helped shape how I understand compassion today—and it continually inspires the way I show up for others in moments of loss.

Supporting One Another Through the Process

Grief becomes more bearable when it is met with community. In the coming days and weeks, I encourage all of us to:

• Show grace — to yourself and others.

• Lean on the support available — whether through colleagues, friends, mental health resources, or spiritual practices.

• Recognize signs of overwhelm — such as withdrawal, irritability, or fatigue — and reach out when you notice them in others.

• Allow yourself to feel — whatever arises, without judgment.

Healing doesn’t mean forgetting. It means finding ways to carry our memories forward while learning to live with a new kind of normal. 

Sending hugs to anyone who is hurting today.  You do not have to go through it alone.   

Understanding the Quarter-Life Crisis

The term quarter-life crisis describes a period of emotional upheaval and identity questioning that commonly occurs during early adulthood, roughly between the mid‑20s and mid‑30s. According to psychologist Claire Hapke, PsyD, LMFT, this phase is marked by uncertainty, pressure, and reassessment as young adults confront major life decisions with fewer clearly defined milestones than previous generations (Hapke, 2013).

Changing Pathways to Adulthood

Historically, adulthood followed a relatively predictable sequence:

• Graduation

• Full-time employment

• Marriage

• Home ownership

• Parenthood

• Retirement

In contrast, today’s young adults often pursue extended education to increase earning potential, begin adulthood with significant student loan debt, and delay traditional milestones such as marriage and home ownership. Current trends show that the average age of marriage has shifted later—approximately age 29 for men and 27 for women in the United States (U.S. Census Bureau, 2023). These changes have disrupted previously accepted timelines for “success” and stability.

Developmental Tasks of the Quarter-Life Period

During this stage, individuals typically work through several key developmental tasks:

• Transitioning from school to the workforce

• Moving out of the family home

• Working toward financial independence

• Making autonomous decisions

• Renegotiating the caregiver–child relationship with parents

As the structured environment of education ends, young adults encounter the challenge of self‑direction. With fewer external guidelines, many struggle with questions such as Who am I? and What am I supposed to be doing with my life? Research suggests individuals may experience up to seven career changes between the ages of 18 and 30, contributing to feelings of instability and disorientation (Bureau of Labor Statistics, 2022).

Emotional and Behavioral Effects

The uncertainty associated with a quarter-life crisis can manifest in a variety of emotional and behavioral responses, including:

• Depression

• Anxiety

• Decreased motivation

• Low self‑esteem and self‑worth

• Social isolation

• Insecurity

• Substance misuse

• Increased engagement in risky behaviors

Many individuals describe this phase as feeling “cast out to sea”—expected to navigate adulthood independently without a clear map or destination.

Common Quarter-Life Crisis Experiences

Two patterns commonly emerge during this period:

“Locked In”
Individuals may secure stable employment with competitive pay yet feel deeply dissatisfied or trapped. Although externally successful, they experience internal conflict and diminished fulfillment.

“Locked Out”
Others encounter repeated rejection and frustration when attempting to enter desired career fields, often due to limited experience or competitive job markets. This can foster feelings of inadequacy and hopelessness.

Generational Pressures and Social Comparison

Sally White notes that millennials (born approximately between 1980 and 2000) are frequently labeled as narcissistic or entitled, yet these characterizations fail to account for the structural and economic challenges shaping their experiences (White, 2016). The traditional model of success no longer aligns with current realities, and constant social comparison—amplified through social media—can intensify feelings of failure and self‑doubt.

White emphasizes that comparing one’s behind‑the‑scenes struggles to others’ curated online successes is both unrealistic and harmful, often exacerbating quarter-life distress.

Support and Growth During a Quarter-Life Crisis

Experiencing a quarter-life crisis does not indicate personal failure. Instead, it reflects a normative developmental transition within a rapidly changing social and economic landscape. Working with a professional counselor can be beneficial in addressing this phase by focusing on:

• Increasing self‑esteem and self‑worth

• Engaging in identity and self‑exploration

• Differentiating external expectations from internal values

• Clarifying personal wants and needs

• Exploring, committing to, or recommitting to core values

With appropriate support, individuals can use this period as an opportunity for growth, self‑definition, and intentional life planning.

References

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469

Bureau of Labor Statistics. (2022). Number of jobs, labor market experience, and earnings growth among Americans. U.S. Department of Labor. https://www.bls.gov

Hapke, C. (2013). Understanding the quarter-life crisis. Psychology Today. https://www.psychologytoday.com

U.S. Census Bureau. (2023). Median age at first marriage: 1890 to present. https://www.census.gov

White, S. (2016). Quarter-life crisis: Defining millennial success [TED Talk]. https://www.ted.com/talks/sally_white_quarter_life_crisis_defining_millenial_success

The Challenges of Making Friends as an Adult: Barriers and Strategies for Connection

Friendship is a critical component of psychological well-being, yet adults often struggle to form new social bonds. This article examines the unique challenges adults face in building friendships, including structural, psychological, and cultural factors, and provides evidence-based strategies to foster meaningful connections. Recommendations are grounded in research on social psychology, mental health, and adult development.

Friendship plays a vital role in emotional health, resilience, and life satisfaction (Demir & Davidson, 2013). While childhood and adolescence offer abundant opportunities for social interaction, adulthood introduces barriers such as time constraints, geographic mobility, and shifting priorities. Understanding these challenges and identifying practical strategies is essential for promoting social connectedness and reducing loneliness—a growing public health concern (Holt-Lunstad et al., 2015).

Challenges in Adult Friendship Formation

1. Time Constraints

Work, family, and caregiving responsibilities often leave adults with limited time for social engagement (Rawlins, 2017). Unlike school environments, adulthood lacks structured opportunities for spontaneous interaction.

2. Reduced Social Structures

Educational settings naturally facilitate friendships through shared experiences. In adulthood, these structures diminish, requiring intentional effort to meet new people (Hall, 2019).

3. Fear of Rejection and Vulnerability

Adults may experience heightened anxiety about initiating friendships due to fear of judgment or rejection, particularly in individualistic cultures that emphasize self-sufficiency (Nelson, 2013).

4. Geographic Mobility

Career changes and relocations disrupt established social networks, making it harder to maintain long-term friendships (Oswald & Clark, 2003).

5. Changing Priorities

Adults often prioritize quality over quantity in relationships, seeking deeper connections rather than casual acquaintances (Hall, 2012).

Strategies for Building Friendships

1. Leverage Existing Networks

Reconnecting with acquaintances or colleagues can serve as a foundation for deeper relationships. Research suggests that “weak ties” often lead to meaningful social opportunities (Granovetter, 1973).

2. Engage in Interest-Based Activities

Shared hobbies create natural contexts for interaction. Group activities such as book clubs or volunteer work foster repeated exposure, which is key to friendship development (Montoya et al., 2006).

3. Consistency and Effort

Friendship requires sustained interaction. Regular participation in social activities increases the likelihood of forming bonds (Hall, 2019).

4. Practice Vulnerability

Authenticity and self-disclosure are critical for intimacy in friendships (Reis & Shaver, 1988). Gradual sharing of personal experiences builds trust. Brené Brown has an excellent video (see below) that explains her marble jar theory of how trust is built over time, through small moments and consistency.

5. Utilize Technology

Social media and apps can facilitate initial connections, but transitioning to in-person interaction strengthens relational depth (Chan, 2011).

6. Manage Expectations

Not every interaction will result in a close friendship. Viewing social engagement as a process reduces pressure and promotes enjoyment (Nelson, 2013).

Conclusion

Making friends as an adult is challenging but achievable through intentionality, vulnerability, and consistent effort. Strong social connections enhance mental health, reduce loneliness, and improve overall well-being. By understanding barriers and applying evidence-based strategies, adults can cultivate meaningful relationships that enrich their lives.

References

• Chan, D. K. (2011). Social networking sites and personal relationships: Online intimacy and offline distance. Cyberpsychology, Behavior, and Social Networking, 14(5), 253–257.

• Demir, M., & Davidson, I. (2013). Toward a better understanding of the relationship between friendship and happiness: Perceived responses to capitalization attempts. Journal of Happiness Studies, 14(2), 525–550.

• Granovetter, M. S. (1973). The strength of weak ties. American Journal of Sociology, 78(6), 1360–1380.

• Hall, J. A. (2012). Friendship standards: The dimensions of ideal expectations. Journal of Social and Personal Relationships, 29(7), 884–907.

• Hall, J. A. (2019). How many hours does it take to make a friend? Journal of Social and Personal Relationships, 36(4), 1278–1296.

• Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.

• Nelson, L. J. (2013). Emerging adulthood and college students’ identity development. Journal of College Student Development, 54(5), 556–570.

• Oswald, D. L., & Clark, E. M. (2003). Best friends forever? High school best friendships and the transition to college. Personal Relationships, 10(2), 187–196.

• Rawlins, W. K. (2017). Friendship matters: Communication, dialectics, and the life course. Transaction Publishers.

• Reis, H. T., & Shaver, P. (1988). Intimacy as an interpersonal process. In S. Duck (Ed.), Handbook of personal relationships (pp. 367–389). Wiley.