Pharmacotherapy in dementia with lewy bodies

Abstract

Pharmacological management of dementia with Lewy bodies (DLB) remains challenging, because it is complicated by the risk of adverse reactions to medication. Treatments for one aspect of the disease may exacerbate other symptoms. In this chapter, I will introduce the results of pharmacological trials mainly investigating cognitive impairment and neuropsychiatric symptoms for DLB and Parkinson’s disease and dementia (PDD), both separately and together. A recent meta-analysis indicated beneficial effects of donepezil and rivastigmine for cognitive and psychiatric symptoms, and these two drugs may be effective for improving cognition and reducing neurobehavioral disturbances over 1 year. Memantine can be used safely in patients with DLB and PDD, but its effects on symptoms may be variable. When using antipsychotics in DLB or PDD, the likely balance of risks vs. benefits requires very careful consideration. Agents that can modify underlying disease processes such as alpha-synuclein accumulation will be promising treatment candidates.