Dementia with Lewy bodies: Clinical management

Psychosis and associated behavioral disturbances are common features of dementia with Lewy bodies (DLB) and appear to be relatively independent of the severity of cognitive impairment or stage of disease. The occurrence of sensitivity reactions in 50%-60% of neuroleptic-treated patients is a major limitation to clinical management. Dopamine blockade may be an inappropriate pharmacological strategy for the core features of DLB, which postmortem studies have revealed to have an underlying neurobiological basis in cholinergic neurotransmitter deficits. In a double-blind, placebo controlled study, the cholinesterase inhibitor rivastigmine was administered to 120 patients clinically diagnosed as DLB according to Consensus criteria. A cluster of treatment-responsive DLB symptoms - apathy, hallucinations, delusions, and anxiety - was identified. Other neuropsychiatric features including aggression, agitation, and depression were unaffected. Cognitive performance also improved, the largest effects being observed for computer-based attentional performance tasks. Extrapyramidal motor features were not worsened.