Tiapride for the Treatment of REM Sleep Behaviour Disorder in Dementia with Lewy Bodies: A Case Series

Abstract

Objective: REM sleep Behaviour Disorder (RBD) in Dementia with Lewy bodies (DLB) may be attributed to a decrease in dopaminergic neurotransmission. Thus, we studied the therapeutic efficacy of the pre and postsynaptic D2 and D3 receptor antagonist tiapride, which at a low dosage preferentially blocks presynaptic dopamine receptors and consequently leads to feedback activation of dopamine synthesis and to increased extracellular levels of dopamine. Methods: Six consecutive patients presenting at our memory clinic with RBD in DLB, in whom melatonin had been ineffective and clonazepam was found inappropriate for clinical reasons, were treated with triapride at dosages between 50 and 150 mg for twelve weeks. Results: Tiapride was well tolerated by all patients. Five of the six patients, reported was a decrease of the self-perceived frequency of bad dreams and the intensity and severity of motor and vocal enactments during sleep. In four of these six patients, this was also the case in the view of the patients’ bed partners. Conclusion: Tiapride may by an effective and well-tolerated treatment for RBD in patients with DLB.