What is the role of medication in the treatment of dementia with Lewy bodies (DLB), and which drugs are used?

Updated: Aug 08, 2019
  • Author: Howard A Crystal, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

As yet, no compelling data indicate that medications can decrease the rate of cognitive decline. Medications can be used to treat agitation and hallucinations, as well as depression, and to improve cognition and/or alertness.

Acetylcholinesterase inhibitors should usually be the first drugs used to treat hallucinations and agitation in patients with dementia with Lewy bodies (DLB). Studies also indicate that administering cholinesterase inhibitors to these patients can improve neuropsychological test scores. [23]

Regarding nonspecific partial glutamate antagonists, memantine has been approved in the United States for the treatment of moderate to severe Alzheimer disease. It is not approved for the treatment of Parkinson disease or DLB.

A double-blind, placebo-controlled, multicenter trial of memantine in 72 patients with DLB or Parkinson disease dementia found that after 24 weeks of treatment, patients taking memantine had better clinical global impression of change scores than did those taking placebo. [24, 25] A few case reports have noted that memantine may exacerbate fluctuations.

Although clonazepam has been considered the treatment of choice for rapid eye movement sleep behavior disorder in patients with DLB, melatonin may be beneficial, either alone or in combination with clonazepam. Melatonin may be administered at 3mg at bedtime. [27]


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