Drug Treatment in Lewy Body Dementia

Abstract

The treatment of Lewy body dementia (LBD) is particularly difficult for the co-occurrence of psychiatric and parkinsonian symptoms: antipsychotic drugs can worsen parkinsonism, and antiparkinsonian drugs can precipitate delusions and hallucinations. The aim of this study was to describe treatment strategies and outcomes of 10 clinically diagnosed LBD patients. Two patients had mainly motor symptoms, L-dopa therapy was moderately successful, and psychotic symptoms did not worsen. Eight had relevant psychiatric symptoms needing neuroleptic therapy. Six of these had sufficient response to low-dose neuroleptics and 2 did not respond; parkinsonism worsened in all 8 and L-dopa therapy or treatment with an antiparkinsonian drug was started in 6. L-Dopa or antiparkinsonian drugs were given also to those 2 patients who did not receive neuroleptics. Of the 8 patients taking L-dopa or antiparkinsonian drugs, 6 had a moderate or good response with no or only mild adverse effects. Psychiatric symptoms were sensitive to trazodone or clozapine in 2 patients, without side effects. A flow chart of drug therapy in LBD is proposed.

Donepezil for dementia with Lewy bodies: a case study

“…She had suered from severe visual hallucinations, cognitive impairment with marked¯uctuations, parkinsonism, repeated falls, syncopes and neuroleptic sensitivity. As reported previously (McKeith et al, 1996;Geroldi et al, 1997;Burke et al, 1998), therapy with neuroleptics, including atypical agents like risperidone and clozapine, induced rigidity and severe sedation with unconsciousness. We believe that donepezil was the main reason for improvement in this subject.…”

Clinical Diagnosis of Dementia with Lewy Bodies in a Japanese Dementia Registry

“…Severe adverse reactions to neuroleptics have often been observed in DLB patients [39,42,43]. In this study, 63% of the DLB patients with a history of medication showed a sensitivity to neuroleptics, and accordingly, their daily dose was reduced.…”

Neuropsychiatric aspects of dementia with lewy bodies

“…patients with confirmed AD who had been given neuroleptics and reporteded that neuroleptic sensitivity was much more common in DLB patients and that sensitivity reactions occurred despite low doses and the use of newer agents. Geroldi et al [50] recommended trazodone, which is widely used for agitation, sleep disorders, and disruptive behavior in dementia because of its sedative effect and negligible anticholinergic activity. However, the efficacy of trazodone for patients with DLB has not been studied thoroughly.…”

“…investigators have recommended atypical compounds such as clozapine, risperidone, olanzapine, and quetiapine for patients with DLB[48][49][50][51]. These agents are mixed dopamine and serotonin antagonists[52].…”