Dementia With Lewy Bodies Treatment & Management

  • Author: Howard A Crystal, MD; Chief Editor: Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA   more...
 
Updated: Feb 1, 2012
 

Approach Considerations

Hallucinations and agitation are especially troublesome in dementia with Lewy bodies (DLB). When these symptoms are mild, no medical treatment may be necessary. When medication is used, acetylcholinesterase inhibitors should usually be tried first. For example, double-blinded, placebo-controlled studies have demonstrated that the cholinesterase inhibitor rivastigmine may decrease psychiatric symptoms associated with DLB, particularly apathy, anxiety, hallucinations, and delusions.[19]

Studies have also shown that patients with DLB treated with cholinesterase inhibitors do better on neuropsychological tests than do subjects treated with placebo.[20] Cholinesterase inhibitors that may be effective in the treatment of DLB also include donepezil and galantamine. In a small minority of patients, motor features are worsened with cholinesterase inhibitors.

Most experts recommend atypical neuroleptics such as clozapine, quetiapine, or aripiprazole when cholinesterase inhibitors are ineffective. Avoid standard neuroleptics, such as haloperidol, because of neuroleptic sensitivity.

Some experts have tried antiepileptic drugs to treat agitation and hallucinations, but clinical data supporting their use is lacking.

Studies suggest that memantine improves cognitive function and neuropsychiatric features in patients with DLB. A multicenter, double-blinded, placebo-controlled trial revealed significant improvement in 2 important measurement tools in patients who received the drug: the Alzheimer's Disease Cooperative Study clinical global impression of change score (memantine vs placebo, 3.3 vs 3.9) and the Neuropsychiatric Inventory score (memantine vs placebo, -4.3 vs 1.7).[21, 22]

Levodopa/carbidopa may improve motor function in some patients with DLB; however, in many patients this combination has no effect and may exacerbate psychiatric symptoms or confusion.

Depression is frequent in patients with DLB; it may occur as a result of damage in the dorsal raphe and locus ceruleus and/or as a psychological response to impaired function. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice for treating depression in DLB.

Consultations

Spouses, family members, and caregivers of patients with DLB frequently realize that the patient with DLB behaves differently than typical patients with Alzheimer disease. Primary caregivers (or neurologists not specializing in dementia) frequently are unable to adequately explain these differences. In such situations, referral to a dementia specialist can be helpful.

Diet

No dietary restrictions are indicated except for patients with severe disease who have swallowing impairment.

Activity

Physical therapy and exercise classes can be useful for maintaining the patient’s mobility. Advise families of potential problems faced by patients with DLB who drive.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Howard A Crystal, MD  Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center

Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

Chief Editor

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA  Professor of Neurology, University of Central Florida College of Medicine; Director of Cognitive Neurology, Director of Stroke Program, James A Haley Veterans Affairs Hospital

Michael Hoffmann, MBBCh, MD, FCP(SA), FAAN, FAHA is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Heart Association, and American Society of Neuroimaging

Disclosure: Nothing to disclose.

Additional Contributors

Robert A Hauser, MD, MBA Professor of Neurology, Molecular Pharmacology and Physiology, Director, Parkinson's Disease and Movement Disorders Center, University of South Florida; Clinical Chair, Signature Interdisciplinary Program in Neuroscience

Robert A Hauser, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, and Movement Disorders Society

Disclosure: Adamas Pharmaceuticals Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology. Nov 1996;47(5):1113-24. [Medline].

  2. McKeith IG, Perry EK, Perry RH. Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Consortium on Dementia with Lewy Bodies. Neurology. Sep 22 1999;53(5):902-5. [Medline].

  3. McKeith IG, Ballard CG, Perry RH, et al. Prospective validation of consensus criteria for the diagnosis of dementia with Lewy bodies. Neurology. Mar 14 2000;54(5):1050-8. [Medline].

  4. Verghese J, Crystal HA, Dickson DW, Lipton RB. Validity of clinical criteria for the diagnosis of dementia with Lewy bodies. Neurology. Dec 10 1999;53(9):1974-82. [Medline].

  5. McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. Dec 27 2005;65(12):1863-72. [Medline].

  6. Ferman TJ, Smith GE, Boeve BF, et al. DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. Neurology. Jan 27 2004;62(2):181-7. [Medline].

  7. Serra L, Cercignani M, Basile B, Spanò B, Perri R, Fadda L, et al. White Matter Damage along the Uncinate Fasciculus Contributes to Cognitive Decline in AD and DLB. Curr Alzheimer Res. Jan 23 2012;[Medline].

  8. Nagahama Y, Okina T, Suzuki N, Matsuda M. Neural correlates of psychotic symptoms in dementia with Lewy bodies. Brain. Nov 17 2009;[Medline].

  9. Perez F, Helmer C, Dartigues JF, Auriacombe S, Tison F. A 15-year population-based cohort study of the incidence of Parkinson's Disease and dementia with Lewy bodies in an elderly French cohort. J Neurol Neurosurg Psychiatry. Dec 3 2009;[Medline].

  10. McKeith IG, Rowan E, Askew K, et al. More severe functional impairment in dementia with lewy bodies than Alzheimer disease is related to extrapyramidal motor dysfunction. Am J Geriatr Psychiatry. Jul 2006;14(7):582-8. [Medline].

  11. Nelson PT, Kryscio RJ, Jicha GA, Abner EL, Schmitt FA, Xu LO, et al. Relative preservation of MMSE scores in autopsy-proven dementia with Lewy bodies. Neurology. Oct 6 2009;73(14):1127-33. [Medline].

  12. Sonnesyn H, Nilsen DW, Rongve A, Nore S, Ballard C, Tysnes OB, et al. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28(4):307-13. [Medline].

  13. Clark CM, Xie S, Chittams J, et al. Cerebrospinal fluid tau and beta-amyloid: how well do these biomarkers reflect autopsy-confirmed dementia diagnoses?. Arch Neurol. Dec 2003;60(12):1696-702. [Medline].

  14. Small GW. Neuroimaging as a diagnostic tool in dementia with Lewy bodies. Dement Geriatr Cogn Disord. 2004;17 Suppl 1:25-31. [Medline].

  15. Walker RW, Walker Z. Dopamine transporter single photon emission computerized tomography in the diagnosis of dementia with Lewy bodies. Mov Disord. 2009;24 Suppl 2:S754-9. [Medline].

  16. Lim SM, Katsifis A, Villemagne VL, Best R, Jones G, Saling M, et al. The 18F-FDG PET cingulate island sign and comparison to 123I-beta-CIT SPECT for diagnosis of dementia with Lewy bodies. J Nucl Med. Oct 2009;50(10):1638-45. [Medline].

  17. Brooks DJ. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy bodies with positron emission tomography. Mov Disord. 2009;24 Suppl 2:S742-7. [Medline].

  18. Villemagne VL, Okamura N, Pejoska S, Drago J, Mulligan RS, Chételat G, et al. Differential Diagnosis in Alzheimer's Disease and Dementia with Lewy Bodies via VMAT2 and Amyloid Imaging. Neurodegener Dis. Jan 17 2012;[Medline].

  19. McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet. Dec 16 2000;356(9247):2031-6. [Medline].

  20. Fernandez HH, Wu CK, Ott BR. Pharmacotherapy of dementia with Lewy bodies. Expert Opin Pharmacother. Nov 2003;4(11):2027-37. [Medline].

  21. [Best Evidence] Emre M, Tsolaki M, Bonuccelli U, Destée A, Tolosa E, Kutzelnigg A, et al. Memantine for patients with Parkinson's disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. Oct 2010;9(10):969-977. [Medline].

  22. Aarsland D, Ballard C, Walker Z, Bostrom F, Alves G, Kossakowski K, et al. Memantine in patients with Parkinson's disease dementia or dementia with Lewy bodies: a double-blind, placebo-controlled, multicentre trial. Lancet Neurol. Jul 2009;8(7):613-8. [Medline].

  23. Boeve BF, Silber MH, Ferman TJ. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med. Jul 2003;4(4):281-4. [Medline].

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