Treatment of dementia with Lewy bodies

Abstract

Dementia with Lewy bodies (DLB) causes various symptoms such as psychiatric symptoms, parkinsonism, and failures of autonomic nervous system in addition to cognitive impairment, all of which are clinical and care problems. This review provides evidence–based commentary on treatment of DLB. Donepezil has been the central means since its approval in 2014 for the treatment of cognitive impairment of DLB, and evidence of it is accumulating and gives clues of the usage of it. Although there is insufficient evidence on the efficacy of donepezil for BPSD, it is still the first choice before antipsychotics. On the other hand, motor disorders due to parkinsonism are also important therapeutic targets. Levodopa is the mainstay of treatment. Recently, multicenter, placebo–controlled, randomizeouble–blind, controlled trials have shown the efficacy of adding zonisamide over levodopa treatment for parkinsonism in DLB. Unfortunately, there is no high level of evidence of treatment for a variety of other conditions, and individual patients will be treated with knowledge of other diseases.