What non-pharmacological interventions are effective in managing the behavioral symptoms associated with Dementia with Lewy Bodies?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For individuals with Dementia with Lewy Bodies (DLB) experiencing behavioural symptoms, non-pharmacological (psychosocial) approaches are recommended as first-line interventions . It is crucial to first conduct a structured assessment to explore possible reasons for distress and to check for and address clinical or environmental causes, such as pain, delirium, discomfort, hunger, loneliness, boredom, over-stimulation, or inappropriate care ,.

  • Addressing Immediate Distress and Challenging Behaviour: If challenging behaviour requires urgent treatment and underlying causes have been addressed, advise moving the person to a safe, low-stimulation environment, such as a quiet room away from others . Utilise verbal and non-verbal de-escalation techniques, including active listening, effective verbal responding, pictures, and symbols . Offer personalised activities to promote engagement, pleasure, and interest for people experiencing agitation or aggression ,.
  • Managing Agitation: Specific non-pharmacological interventions associated with substantial reductions in agitation include massage therapy, animal-assisted intervention, and personally tailored interventions .
  • Addressing Depression and Anxiety: For people with mild to moderate dementia who have mild to moderate depression and/or anxiety, psychological treatments should be considered ,.
  • Managing Sleep Problems: A personalised multicomponent sleep management approach should be considered for sleep problems, which includes sleep hygiene education, exposure to daylight, exercise, and personalised activities ,.
  • Promoting Cognition, Independence, and Wellbeing (for mild to moderate dementia): A range of activities tailored to the person's preferences should be offered to promote wellbeing . Group cognitive stimulation therapy, group reminiscence therapy, and cognitive rehabilitation or occupational therapy to support functional ability may also be considered ,.

It is important to note that for people with DLB, antipsychotics can worsen motor features and, in some cases, cause severe antipsychotic sensitivity reactions, further emphasising the importance of non-pharmacological and environmental interventions ,. Psychosocial and environmental interventions for distress should continue even if antipsychotics are being used or have been stopped ,.

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