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

For individuals with Dementia with Lewy Bodies (DLB) experiencing behavioural symptoms, non-pharmacological (psychosocial) approaches are recommended as first-line interventions ¹. 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 ¹,².

• 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 ¹. Utilise verbal and non-verbal de-escalation techniques, including active listening, effective verbal responding, pictures, and symbols ¹. Offer personalised activities to promote engagement, pleasure, and interest for people experiencing agitation or aggression ¹,².
• Managing Agitation: Specific non-pharmacological interventions associated with substantial reductions in agitation include massage therapy, animal-assisted intervention, and personally tailored interventions ¹.
• 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 ¹,².
• 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 ¹,².
• 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 ². Group cognitive stimulation therapy, group reminiscence therapy, and cognitive rehabilitation or occupational therapy to support functional ability may also be considered ¹,².

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 ¹,². Psychosocial and environmental interventions for distress should continue even if antipsychotics are being used or have been stopped ¹,².