A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms

Abstract

BackgroundDementia with Lewy bodies (DLB) is a progressive form of dementia, accompanied by a range of behavioural and psychological symptoms. The aim of this study was to identify current clinical practice for the treatment of DLB in Japan.MethodsWe conducted a survey of medical doctors engaged in the management of dementia in Japan. Participants were divided into two groups: psychiatrists (Group P) and neurologists or neurosurgeons (Group NS). Doctors completed a questionnaire and we analysed their responses to compare the two groups with regard to diagnosis and treatment of DLB, and in particular the treatment of behavioural and psychological symptoms of dementia (BPSD).ResultsResponses suggested that Group P conducted biomarker examinations less frequently and decided on their own therapeutic strategies more frequently than did Group NS. Both groups most frequently selected hallucinations/delusions as the symptoms given highest treatment priority. More than 70% of respondents in both groups reported having difficulties in treating BPSD. Atypical antipsychotics were more frequently prescribed by Group P, but were also prescribed in 70% of patients in Group NS. A third of patients received atypical antipsychotics for more than 1 year.ConclusionsThe responses to this survey highlighted the difficulties faced by clinicians managing patients with DLB and identified the need to effectively treat BPSD in such patients.

Differences in the treatment needs of patients with dementia with Lewy bodies and their caregivers and differences in their physicians’ awareness of those treatment needs according to the clinical department visited by the patients: a subanalysis of an observational survey study

“…The physicians in this study were experts in DLB, assuming that levodopa, rather than anticholinergics or dopamine agonists, has been becoming more common as the first-line drug. Furthermore, similar to a previous study [ 7 ], antipsychotics were prescribed less frequently in the N-group compared with the P-group, suggesting that neurologists may have fewer opportunities to prescribe antipsychotics for psychosis. Yokukansan was frequently prescribed in the G-group, and Yokukansan may be effective for neuropsychiatric symptoms according to a recent systematic review [ 18 ].…”

“…This subanalysis study revealed new findings regarding trends in prescribing medications by physician specialty. A previous study suggested differences in prescription rates of first-line medications for parkinsonism between general psychiatrists and neurologists, as well as differences in the prescription rates of antipsychotic medications for behavioral and psychological symptoms of dementia [ 6 , 7 ]. In the present study, neurologists less frequently prescribed cholinesterase inhibitors for cognitive dysfunction than other specialists.…”

“…Of note, a patient with DLB can have multiple concurrent symptoms [ 5 ], and treatment strategies may differ depending on the specialty of the attending physician. A web survey of physicians attending patients with DLB that investigated treatment strategies among different departments demonstrated that psychiatrists were less likely to make parkinsonism a treatment priority, were less likely to prescribe levodopa as a first-line drug for parkinsonism, and were more likely to prescribe antipsychotics for psychiatric symptoms than neurologists and neurosurgeons [ 6 , 7 ].…”

Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project1

“…Irritability (38%), aggression (33%), and aberrant motor activity (17%) are not so frequent, while delusions (11%), hallucinations (9%), and euphoria (1%) are present in lower percentages [17]. Finally, BPSD are also frequent in Lewy body dementia and sometimes very difficult to manage [18]. Furthermore, BPSD are more prominent in younger patients and are associated with loss of functioning [19].…”

Time is brain in dementia

“…Authors observed that the use of biomarkers in this study was quite frequent despite insufficient evidence base for their accuracy. The use of biomarkers to support the diagnosis of cognitive impairment, nonetheless, seems to be an emerging practice (Odawara et al, 2019). More research that would help to clearly establish the use of biomarkers as a reliable diagnostic practice is needed.…”