What Are the Treatment Options for Lewy Body Dementia?

Lewy body dementia (LBD) is a complex disease that typically requires a comprehensive treatment approach. Patients often receive care from a team of medical specialists and other health care professionals, who collaborate to treat each symptom without worsening other symptoms. A comprehensive treatment plan may involve medications; physical, occupational, speech, or other types of therapy; and counseling.

Medications

All medications prescribed for LBD are approved by the U.S. Food and Drug Administration to treat symptoms of other diseases, such as Alzheimer’s disease and Parkinson’s disease. These medications can treat cognitive, movement, sleep, mood, and behavioral changes in LBD. There are not yet any medications that slow or stop the progression of LBD.

Cognitive symptoms

Medications called cholinesterase inhibitors are considered the standard treatment for cognitive symptoms in people with LBD. These medications are approved to treat symptoms of Alzheimer’s disease like memory loss and confusion. However, some researchers believe that people with LBD may be even more responsive them. These drugs sometimes help control behavior problems and hallucinations as well. Another medication that may be helpful is memantine.

Movement symptoms

Movement symptoms may be treated with a Parkinson’s medication called carbidopa/levodopa. However, if the symptoms are mild, it may be best to not treat them to avoid potential medication side effects.

Visual hallucinations

If hallucinations are not disruptive, they may not need to be treated. However, if they are frightening or create challenging behaviors, a physician may recommend treatment. Cholinesterase inhibitors are sometimes effective in treating hallucinations and other psychiatric symptoms of LBD. In addition, atypical antipsychotic medications may be tried. Most LBD experts prefer quetiapine or clozapine for safety or quality-of-life concerns. Caution is required to find the lowest effective dose. A newer medication, pimavanserin, was approved to treat psychosis (including hallucinations and delusions) in people with Parkinson’s disease. Results from a clinical trial of this medication in people with dementia and psychosis are pending.

While traditional antipsychotic medications such as chlorpromazine and haloperidol are commonly prescribed for people with Alzheimer’s with disruptive behavior, these medications may cause severe side effects in those with LBD. For this reason, traditional antipsychotic medications should be avoided.

WARNING: Up to half of LBD patients treated with any antipsychotic medication may have a severe reaction, such as worsening confusion, heavy sedation, and increased or possibly irreversible parkinsonism. If severe fever or muscle rigidity occurs, contact a doctor immediately. This may be a potentially life-threatening condition that is treated by stopping the medication.

REM Sleep Behavior Disorder (RBD)

RBD can be quite responsive to treatment. A physician may recommend a medication like melatonin and/or clonazepam.

Special treatment considerations

Medication side effects

Ask your doctor about possible side effects of any medication. The following types of drugs may cause sedation, movement impairment, or confusion:

•    Benzodiazepines, such as diazepam and lorazepam
•    Anticholinergics (antispasmodics), such as oxybutynin and glycopyrrolate
•    Older antidepressants
•    Certain over-the-counter medications, including diphenhydramine and dimenhydrinate
•    Some medications that help relieve parkinsonian symptoms, like anticholinergics, amantadine, and dopamine agonists

Surgery and anesthesia

Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD. People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium. They may have a sudden significant drop in functional abilities, which may be permanent. Possible alternatives to general anesthesia include a spinal or regional block. These methods are less likely to result in postoperative confusion. If you are told to stop taking all medications prior to surgery, consult with your doctor to develop a plan for careful withdrawal.

Other types of treatments

•    Lifestyle interventions include eating a healthy diet, exercising, and remaining socially active.
•    Physical therapy includes cardiovascular, strength, and flexibility exercises, as well as gait training.
•    Speech therapy may improve low voice volume, poor enunciation, muscular strength, and swallowing difficulties.
•    Occupational therapy helps maintain skills and promotes functional ability and independence.
•    Music therapy and aromatherapy may reduce anxiety and improve mood.
•    Individual and family psychotherapy may be useful for learning strategies to manage emotional and behavioral symptoms and to help make plans that address individual and family concerns about the future.
•    Support groups may be helpful for caregivers and people with LBD to identify practical solutions to day-to-day frustrations and to obtain emotional support from others.