Dementia with Lewy Bodies
This article provides a comprehensive overview of Dementia with Lewy Bodies (DLB), the second most common type of degenerative dementia after Alzheimer's disease. It highlights the symptoms and progression of DLB, including cognitive fluctuations, visual hallucinations, Parkinsonism, and REM sleep disorders. The article emphasizes that treatment for DLB is symptomatic, focusing on specific disease manifestations, and includes both non-pharmacological and pharmacological measures. Special attention is given to the sensitivity of individuals with DLB to antipsychotic drugs and the potential severe side effects.
2023-12-31 17:47:35 - Editor
Symptoms and Progression of Dementia with Lewy Bodies
Dementia with Lewy bodies (DLB) is the second most common type of degenerative dementia after Alzheimer disease. In addition to dementia, patients with DLB commonly have cognitive fluctuation, inattention, visual hallucinations, dysautonomia, rapid eye movement (REM) sleep disorders, and Parkinsonism. Cognitive disorder in DLB usually progresses inexorably to death.
Symptomatic Treatment of DLB
Treatment of DLB is symptomatic. Treatment only targets specific disease manifestations, and is based on limited evidence. Treatment includes both non-pharmacological and pharmacological measures.
Non-Pharmacological Management Strategies
Non-pharmacological measures include behavioral strategies aimed at modifying stressors in the patient’s environment. Physical therapy and mobility aids may help in the management of Parkinsonism and gait dysfunctions. Patient and caregiver education regarding risks, benefits, and limitations of treatments is important. Cholinesterase inhibitors represent the main pharmacological treatment in DLB. They include rivastigmine and donepezil. Memantine could be an alternative option.
Caution with Antipsychotic Medications
Nearly 30-50% of individuals with DLB have severe sensitivity to antipsychotic drugs, resulting in exacerbation of Parkinsonism, confusion, or autonomic dysfunction. When antipsychotic agents, including olanzapine and quetiapine, are required, patients and caregivers should be warned about the possibility of severe side effects.
References
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