What pharmacological treatments are recommended for managing the symptoms of Dementia with Lewy Bodies, particularly for cognitive and behavioral symp

For the management of cognitive symptoms in Dementia with Lewy Bodies (DLB), acetylcholinesterase (AChE) inhibitors are recommended ¹,². Specifically, donepezil or rivastigmine are recommended as first-line options for people with mild to moderate DLB ¹,². Galantamine may be considered if donepezil and rivastigmine are not tolerated ¹,². For severe DLB, donepezil or rivastigmine are also recommended ¹,². Memantine, an N-methyl-D-aspartic acid receptor antagonist, may be considered if AChE inhibitors are not tolerated or are contraindicated ². It is important to note that the use of AChE inhibitors or memantine for non-Alzheimer's dementia, including DLB, is unlicensed, but they may be prescribed by a specialist ¹,².

Regarding behavioral symptoms, non-pharmacological (psychosocial) approaches are recommended as first-line management ¹,². Before considering pharmacological measures, people with dementia should be assessed for possible clinical causes of challenging behaviour, such as pain, delirium, or discomfort, and these underlying causes should be addressed ¹,².

Antipsychotics should only be offered for people with dementia who are at risk of harming themselves or others, or who are experiencing agitation, hallucinations, or delusions that are causing severe distress ¹,². However, it is crucial to be aware that in people with DLB, antipsychotics can worsen motor features of the condition and, in some cases, cause severe antipsychotic sensitivity reactions ¹,². If antipsychotics are used, they should be initiated under specialist supervision, at the lowest effective dose, and for the shortest possible time ¹,². Treatment should be reassessed at least every six weeks, and stopped if there is no clear ongoing benefit ². Risperidone and haloperidol are the only antipsychotics licensed for treating non-cognitive symptoms of dementia, though others may be prescribed off-label ¹. Discussion of benefits and harms with the person and their family or carers should occur before starting antipsychotics ².