Please note: as with all of the information in this website, this is a general overview only and not to be taken as medical advice. The author of this website urges anyone concerned about Dementia with Lewy bodies to contact an experienced medical practitioner for further guidance.
Unlike diagnostic criteria, officially sanctioned guidelines for treatment of Dementia with Lewy bodies have not yet been agreed or published. Treatment consists of managing symptoms by both pharmaceutical and non-pharmaceutical interventions. There is no universal response to either the drugs or non-medical therapies. Reactions are as diverse as each person involved.
As many as half of people with DLB who receive anti-psychotic drugs suffer extremely serious side effects and greatly increase their mortality risk so these drugs should be avoided if possible. These are some of those drugs. The common trade names are followed by the generic name:
- Clopixol (Clopenthixol)
- Dolmatil, Sulparex, Sulpatil (Sulpiride)
- Haldol, Serenace (Haloperidol)
- Largactil (Chlorpromazine)
- Modecate (Fluphenazine)
- Sparine (Promazine)
- Stelazine (Trifluoperazine)
If tranquillising drugs are to be given, for example to control hallucinations, the newer "atypical" neuroleptics may be used under the advice and care of a specialist doctor such as a psychiatrist or a neurologist. These generally have fewer side effects than the older drugs but may increase the risk of stroke and must be used with great caution [1]. They include:
- Risperdal (Risperidone)
- Seroquel (Quetiapine)
- Zyprexa(Olanzapine)
Some drugs, known as cholinesterase inhibitors (CHels)have been shown to improve cognition and decrease hallucinations in people with DLB [2, 3]. These drugs, however, which are used to slow the progress of Alzheimer's disease, are not licensed in the UK for use in DLB. Indeed the National Institute for Clinical Excellence has restricted prescribing these drugs to people with advanced AD. Unfortunately CHels can sometimes cause or worse Parkinsonian symptoms such as drop of blood pressure upon standing (orthostatic hypotension) or falls [4].
Similarly, the Parkinson's disease drug, Sinemet (levodopa with carbidopa) may alleviate motor symptoms in DLB patients but can also worsen hallucinations and other psychotic symptoms [5].
Non-medical treatment includes environmental changes such as lighting, visual stimulation or music therapy. A study is underway evaluating possible benefits of essential oils used in aromatherapy for people with dementia. Some physical symptoms can be managed non-pharmaceutically. Orthostatic hypotension might be avoided by making sure the patient rises slowly. Constipation can be dealt with by increasing dietary fibre and ensuring adequate hydration. Special drink thickeners can prevent choking on liquids and feeding with pureed foods can help patients with difficulties swallowing.top
- 1. Sink, K.M., Holden K.F., Yaffe K., Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293: 596-608
- 2. McKeith I.G., Del Ser T., Spano P., Emre M., Wesnes K., Anand R., et al., Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000; 356: 2031-6
- 3. Wild R., Pettit, T., Burns A., Cholinesterase inhibitors for dementia with Lewy bodies. Cochrane Database Syst Rev 2003(3): CD003672
- 4. Neff D., Walling A., Dementia with Lewy bodies: an emerging disease. JAAFP 2006; 73(7): 1223-29
- 5. Mosimann U.P., McKeith I.G., Dementia with Lewy bodies — diagnosis and treatment. Swiss Med Wkly 2003; 133: 131-42
