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Treatment of Dementia with Lewy Bodies and Parkinson’s Disease Dementia

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Abstract

Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) account for 10–15% of late onset dementias. Key treatment targets include cognitive and functional impairments, neuropsychiatric symptoms including intense and persistent visual hallucinations, and parkinsonism. Six-month, placebo-controlled randomized controlled trials (RCTs) of the cholinesterase inhibitor rivastigmine have indicated modest but significant benefits in cognition, function, global outcome and neuropsychiatric symptoms in both PDD and DLB. The evidence base for other cholinesterase inhibitors from RCTs is inconclusive. More recent RCTs with memantine in PDD/DLB patients indicate a benefit with regard to global outcome, with some suggestion of a specific benefit with respect to sleep disturbance. Given the risk of severe antipsychotic sensitivity reactions, antipsychotics should be avoided. A significant proportion of PDD/DLB patients are responsive to levodopa, but care needs to be taken with anti-parkinsonian treatments because of their potential propensity to exacerbate neuropsychiatric symptoms, particularly hallucinations.

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Acknowledgements

Clive Ballard has received research grants and honoraria from Novartis and Lundbeck and honoraria from Eisai. Anne Corbett has acted as a consultant to Acadia and has received speaker fees from Lundbeck and Novartis. Zunera Kahn has no conflicts of interest that are directly relevant to the content of this review.

The authors would like to thank the Alzheimer’s Society (UK) for supporting the time of Clive Ballard and Anne Corbett in the preparation of the article. The Alzheimer’s Society had no other input into the preparation or content of this article.

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Authors and Affiliations

  1. Wolfson Centre for Age-Related Diseases, Wolfson Building, King’s College London, Guy’s Campus, London, SE1 1UL, UK

    Clive Ballard & Zunera Kahn

  2. Alzheimer’s Society, London, UK

    Anne Corbett

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  1. Clive Ballard
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  2. Zunera Kahn
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  3. Anne Corbett
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Correspondence to Clive Ballard.

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Ballard, C., Kahn, Z. & Corbett, A. Treatment of Dementia with Lewy Bodies and Parkinson’s Disease Dementia. Drugs Aging 28, 769–777 (2011). https://doi.org/10.2165/11594110-000000000-00000

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  • DOI: https://doi.org/10.2165/11594110-000000000-00000

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