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Syndrome and Treatment Overview of Dementia With Lewy Bodies A DGReview of :"Pharmacotherapy of dementia with Lewy bodies" Expert Opinion on Pharmacotherapy 12/02/2003 By Jill Taylor The underlying pathology and neurochemical deficits associated with dementia with Lewy bodies (DLB) makes treatment particularly challenging, say researchers in an recent review regarding DLB pharmacotherapy. The hallmark of DLB pathology is the presence of Lewy bodies in brainstem nuclei, subcortical regions, and cerebral cortices. The syndrome combines the cognitive features of Alzheimer's disease (AD) and the extrapyramidal symptoms of Parkinson's disease (PD), and the relationship of DLB to AD and PD is controversial. Furthermore, the overlap complicates the assessment of DLB prevalence and impact, say Hubert H. Fernandez, MD, and colleagues of Memorial Hospital of Rhode Island, Pawtucket, United States. Evidence from autopsy series on demented patients suggests that between 15% to 30% meet neuropathological criteria for DLB diagnosis, potentially making DLB the second most common cause of dementia after AD. Although no drugs are officially approved for DLB treatment, limited experience from clinical trials as well as past experience with treatment of patients with AD and PD give clinicians a basis for drug choices for specific target signs and symptoms. However, the potential for adverse medication side effects is greater in these patients than in those with AD or PD as the sole pathology. Because the degree to which each patient exhibits symptoms is variable, individualised treatment is necessary. Prior to treatment, the establishment of a target symptom hierarchy is recommended to guide the treatment plan, instituting one drug at a time. In general, the management of psychosis and other behavioural disturbances (including anxiety, depression, and sleep disturbances) in DLB follow the guidelines of geriatric psychopharmacology. For cognitive impairment in DLB, the mainstay of treatment is cholinesterase inhibitor drugs, which also reduce symptoms of psychosis. DLB patients are extremely sensitive to the extrapyramidal side effects of neuroleptic medications, making atypical antipsychotics, such as quetiapine, the only recommended alternative psychosis treatment. Selective serotonin re-uptake inhibitors are recommended for anxiety and depression, and REM sleep behaviour disorder may be treated with low dose clonazepam. For treatment of Parkinsonism, levodopa is preferred over dopamine agonists due to its lower propensity to cause hallucinations and somnolence. Recently, acetylcholinesterase inhibitors have been reported to simultaneously control symptoms of agitation, anxiety, depression and irritability in DLB patients, as well as improve cognitive impairment. The researchers note that DLB treatment recommendations provided in the published review are based primarily on anecdotal reports and clinical experience. "As the diagnostic criteria for DLB become more refined and validated by post-mortem studies, it is hoped that rigorous, well-designed trials will be performed, aimed at alleviating the primary target symptoms of dementia, psychosis and Parkinsonism," they conclude. Expert Opin Pharmacother 2003 Nov;4:11:2027-37. "Pharmacotherapy of dementia with Lewy bodies" http://tinyurl.com/xhrm SOURCE: Doctor's Guide (press release) http://tinyurl.com/xhry * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn