Pharmacological treatment of cognitive impairments and BPSD in dementia with Lewy bodies

Yasuhiro Nagahama

Kawasaki Memorial Hospital

Clinical features of dementia with Lewy bodies (DLB) include cognitive impairments, fluctuating consciousness, psychoses, and parkinsonism. Cognitive impairments in DLB are characterized by lesser memory impairment and more severe visuospatial/attentional disability. Psychoses are classified into hallucinations, misidentifications, and delusions. Cholinesterase inhibitors (ChEIs) are beneficial for cognitive impairments, fluctuating consciousness, and psychoses. Within psychoses, visual hallucinations show good response to ChEIs, but misidentifications and delusions show modest response. Evidence for benefit of memantine on cognitive and behavioral issues in DLB is inconclusive. Given the risk of severe antipsychotic sensitivity reactions, clinicians should be very careful to use even atypical antipsychotics. Some benefits are suggested for antidepressant (selective serotonin reuptake inhibitors), valproate, ramelteon, gabapentin, and yokukansan for behavioral and mood disturbance.

Keywords:Dementia with Lewy bodies, cognitive impairment, BPSD, cholinesterase inhibitor, memantine, antipsychotics, antidepressant

Address correspondence to Dr. Yasuhiro Nagahama, Kawasaki Memorial Hospital (20-1 Shiomidai, Miyamae-ku, Kawasaki-city, Kanagawa 216-0013, Japan)