Treatment

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 Lewy Body Society 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.

Antipsychotic drugs are sometimes prescribed to people with dementia who have troublesome hallucinations or agitation. These are used with great caution because they may increase the risk of stroke-like episodes. As many as half of people with DLB who receive anti-psychotic drugs additionally suffer extremely serious side effects that may greatly increase their mortality risk and so these drugs should be avoided if at all 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)
  • Seroquel (Quetiapine)
  • Sparine (Promazine)
  • Stelazine (Trifluoperazine)
  • Risperdal (Risperidone)
  • Zyprexa(Olanzapine)

Sometimes very distressing symptoms that cannot otherwise be dealt with, lead to the suggestion of a trial of one of these drugs to see if it produces benefit. If so, this should always be under the advice and care of a specialist doctor such as a psychiatrist or a neurologist, and it is very important that they are reminded that the diagnosis is DLB.[1]. They include:

Some drugs, known as cholinesterase inhibitors (CHels) have been shown to improve cognition and decrease hallucinations in people with DLB[2,3]. These drugs, which are recommended to treat mild to moderate Alzheimer’s disease, are not licensed in the UK for use in DLB, but are widely used by specialist doctors as a first line treatment. CHels can sometimes cause or worse Parkinsonian symptoms such as a drop of blood pressure upon standing (orthostatic hypotension) or falls, so these need to be monitored for[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, aromatherapy or music therapy. 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.

References

  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