Conclusion

The management of patients with Lewy body-related dementias involves both pharmacological and non-pharmacological measures. The management plan should be developed considering the whole symptom complex and the impact of symptoms on the family and the patient. Patients with PD-D or DLB should be offered treatment with a ChE-I, taking into account expected benefits and potential risks. It is not yet known whether early intervention with ChE-Is confers an advantage compared with later administration. Some behavioural symptoms such as apathy may benefit from a ChE-I, but treatment with antipsychotics may become necessary in some patients with psychotic behaviour. In such instances classical neuroleptics, as well as risperidone and olanzapine, should be avoided. Quetiapine might be considered; however the strongest evidence for efficacy exists for clozapine. The clinician must remain vigilant whichever agent is selected. Although evidence from randomized controlled studies is lacking, SSRIs or SNRIs should be given priority in the treatment of depressive features. Clonazepam, melatonin, and memantine can be tried to treat RBD, and armodafinil may emerge as useful for the treatment of excessive daytime sleepiness.

There are so far no disease-modifying agents available to treat Lewy body diseases; until our understanding of the basic neurobiology of the dementing process improves it is probably premature to expect their development. If successful disease-modifying treatments for AD are demonstrated, for example directed against amyloid neurotoxicity, it is likely that these could also be extended to the Lewy body dementias. For the present time symptomatic treatments are likely to remain the only clinically available options, and given the multiple targets and multiple underlying neurotransmitter abnormalities it seems logical to expect that patient treatment regimens will usually be multiagent and individually tailored.

References

  • 1. McKeith IG, Galasko D, Wilcock GK, et al. Lewy body dementia-diagnosis and treatment. Br J Psychiatry 1995; 167: 709-17.
  • 2. McKeith I, Fairbairn A, Perry R, et al. Neuroleptic sensitivity in patients with senile dementia of Lewy body type. Br Med J 1992; 305: 673-8.
  • 3. Aarsland D, Mosimann UP, McKeith IG. Role of cholinesterase inhibitors in Parkinson’s disease and dementia with Lewy bodies. J Geriatr Psychiatry Neurol 2004; 17: 164-71.
  • 4. Barber R, Newby J, McKeith IG. Lewy body disease. In: Richter RW, Zoeller Richter B (ed.), Current clinical neurology. Alzheimer’s disease: a physician’s guide to practical management. Totowa, NJ: Humana Press, 2003; pp. 127-35.
  • 5. McKeith I, Dickson D, Emre M, et al. Dementia with Lewy bodies: diagnosis and management: Third Report of the DLB Consortium. Neurology 2005; 65: 1863-72.
  • 6. Emre M, Aarsland D, Brown R, et al. Clinical diagnostic criteria for dementia associated with Parkinson disease. Mov Disord 2007; 22: 1689-707.
  • 7. Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007; 6: 734-46.
  • 8. Cohen-Mansfield J. Non-pharmacological management of DLB. In O’Brien J, McKeith I, Ames D, et al. (ed.), Dementia with Lewy bodies. Taylor and Francis London, 2005; pp. 103-206.
  • 9. Hindle JV, Petrelli A, Clare L, et al. Nonpharmacological enhancement of cognitive function in Parkinson’s disease: a systematic review. Mov Disord 2013; 28: 1034-49.
  • 10. Paris AP, Saleta HG, de la Cruz Crespo Maraver M, et al. Blind randomized controlled study of the efficacy of cognitive training in Parkinson’s disease. Mov Disord 2011; 26: 1251-8.
  • 11. Tiroboschi P, Hansen LA, Alford M, et al. Cholinergic dysfunction in diseases with Lewy bodies. Neurology 2000; 54: 407-11.
  • 12. Hutchinson M, Fazzini E. Cholinesterase inhibitors in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1996; 61: 324-5.
  • 13. McKeith I, Del Ser T, Spano PF, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000; 356: 2031-6.
  • 14. Del-Ser T, McKeith I, Anand R, et al. Dementia with Lewy bodies: findings from an international multicentre study. Int J Geriatr Psychiatry 2000; 15: 1034-45.
  • 15. Grace J, Daniel S, Stevens T, et al. Long-term use of rivastigmine in patients with dementia with Lewy bodies: an open-label trial. Int Psychogeriatr 2001; 13: 199-205.
  • 16. Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509-18.
  • 17. Poewe W, Wolters E, Emre M, et al. Long-term benefits of rivastigmine in dementia associated with Parkinson’s disease: an active treatment extension study. Mov Disord 2006; 21: 456-61.
  • 18. Oertel W, Poewe W, Wolters E, et al. Effects of rivastigmine on tremor and other motor symptoms in patients with Parkinson’s disease dementia-a retrospective analysis of a double-blind trial and an open- label extension. Drug Safety 2008; 31: 79-94.
  • 19. Dubois B, Tolosa E, Katzenschlager R et al. Donepezil in Parkinson’s disease dementia: a randomized, double-blind efficacy and safety study Mov Disord 2012; 27: 1230-8.
  • 20. Mori E, Ikeda M, Kosaka K on behalf of Donepezil-DLB Study Investigators. Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial. Ann Neurol 2012; 72: 41-52.
  • 21. Ikeda M, Mori E, Kosaka K. et al on behalf of Donepezil-DLB Study Investigators. Long-term safety and efficacy of donepezil in patients with dementia with Lewy bodies: results from a 52-week, open- label, multicenter extension study. Dem Ger Cog Disord 2013; 36: 229-41.
  • 22. Perry EK, McKeith I, Thompson P, et al. Topography, extent, and clinical relevance of neurochemical deficits in dementia of Lewy body type, Parkinson’s disease and Alzheimer’s disease. Ann NY Acad Sci 1991; 640: 197-202.
  • 23. Wesnes KA, McKeith IG, Ferrara R, et al. Effects of rivastigmine on cognitive function in dementia with Lewy bodies: a randomised placebo-controlled international study using the Cognitive Drug Research computerised assessment system. Dementia Geriatr Cogn Dis 2002; 13: 183-92.
  • 24. Wesnes KA, McKeith I, Edgar C, et al. Benefits of rivastigmine on attention in dementia associated with Parkinson disease. Neurology 2005; 65: 1654-6.
  • 25. O’Brien KK, Saxby BK, Ballard CG, et al. Regulation of attention and response to therapy in dementia by butyrylcholinesterase. Pharmacogenetics 2003; 13: 231-9.
  • 26. Thomas AJ, Burn DJ, Rowan EN, et al. A comparison of the efficacy of donepezil in Parkinson’s disease with dementia and dementia with Lewy bodies. Int J Geriatr Psychiatry 2005; 20: 938-44.
  • 27. Minett TSC, Thomas A, Wilkinson LM, et al. What happens when donepezil is suddenly withdrawn? An open label trial in dementia with Lewy bodies and Parkinson’s disease with dementia. Int J Geriatr Psychiatry 2003; 18: 988-93.
  • 28. Bhanji NH, Gauthier S. Dementia with Lewy bodies: preliminary observations on cholinesterase inhibitor switching. Int Psychogeriatrics 2003; 15: 179.
  • 29. Bhasin M, Rowan E, Edwards K, et al. Cholinesterase inhibitors in dementia with Lewy bodies-a comparative analysis. Int J Geriatr Psychiatry 2007; 22: 890-5.
  • 30. Ridha BH, Josephs KA, Rossor MN. Delusions and hallucinations in dementia with Lewy bodies: worsening with memantine. Neurology 2005; 65: 481-2.
  • 31. Sabbagh M, Hake A, Ahmed S, et al. The use of memantine in dementia with Lewy bodies. J Alzhei- mers Dis 2005; 7: 285-9.
  • 32. Leroi I, Overshott R, Byrne EJ, et al. Randomized, controlled trial of memantine in dementia associated with Parkinson’s disease. Mov Disord 2009; 24: 1217-21.
  • 33. Aarsland D, Ballard C, Walker Z, et al. Memantine in patients with Parkinson’s disease dementia or dementia with Lewy bodies: a double-blind, placebo controlled, multicentre trial. Lancet Neurol 2009;
  • 8: 613-18.
  • 34. Emre M, Tsolaki M, Bonuccelli U, et al. Memantine for patients with Parkinson’s disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2010; 9: 969-77.
  • 35. Molloy S, McKeith I, O’Brien JT, et al. The role of levodopa in the management of dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2005; 76: 1200-3.
  • 36. Aarsland D, Larsen JP, Karlsen K, et al. Mental symptoms in Parkinson’s disease are important contributors to caregiver stress. Int J Geriatr Psychiatry 1999; 14: 866-74.
  • 37. Bostrom F, Jonsson L, Minthon L, et al. Patients with dementia with Lewy bodies have more impaired quality of life than patients with Alzheimer disease. Alzheimers Dis Assoc Disord 2007; 21: 150-4.
  • 38. Bostrom F, Jonsson L, Minthon L, et al. Patients with Lewy body dementia use more resources than those with Alzheimer’s disease. Int J Geriatr Psychiatry 2007; 22: 713-19.
  • 39. McKeith IG, Fairbairn AF, Perry RH, et al. Neuroleptic sensitivity in patients with senile dementia of Lewy body type Br Med J 1992; 305: 673-8.
  • 40. Ballard C, Grace J, McKeith I, et al. Neuroleptic sensitivity in dementia with Lewy bodies and Alzheimer’s disease Lancet 1998: 35: 1032-3.
  • 41. Aarsland D, Ballard C, Larsen JP, et al. Marked neuroleptic sensitivity in dementia with Lewy bodies and Parkinson’s disease. J Clin Psychiatry 2005; 66: 633-7.
  • 42. McKeith IG, Ballard CG, Harrison RWS. Neuroleptic sensitivity to risperidone in Lewy body dementia. Lancet 1995; 346: 699.
  • 43. Walker Z, Grace J, Overshot R, et al. Olanzapine in dementia with Lewy bodies: a clinical study. Int J Geriatr Psychiatry 1999; 14: 459-66.
  • 44. Kurlan R, Cummings J, Raman R, et al. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology 2007; 68: 1356-63.
  • 45. Burke WJ, Pfeiffer RF, McComb RD. Neuroleptic sensitivity to clozapine in dementia with Lewy bodies. J Neuropsychiatry Clin Neurosci 1998; 10: 227-9.
  • 46. Harrison RH, McKeith IG. Senile dementia of Lewy body type—a review of clinical and pathological features: implications for treatment. Int J Geriatr Psychiatry 1995; 10: 919-26.
  • 47. Iwasaki K, Kosaka K, Mori H, et al. Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of a traditional Japanese medicine. Psychogeriatrics 2012; 12: 235-41.
  • 48. Weintraub D, Morales KH, Moberg PJ, et al. Antidepressant studies in Parkinson’s disease: a review and meta-analysis. Mov Disord 2005; 20: 1161-9.
  • 49. Miyasaki JM, Shannon K, Voon V, et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66: 996-1002.
  • 50. Devos D, Dujardin K, Poirot I, et al. Comparison of desipramine and citalopram treatments for depression in Parkinson’s disease: a double-blind, randomized, placebo-controlled study. Mov Disord 2008; 23: 850-7.
  • 51. Menza M, Dobkin RD, Marin H, et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology 2009; 72: 886-92.
  • 52. Richard IH, McDermott MP, Kurlan R, et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease. Neurology 2012; 78: 1229-36.
  • 53. Barone P, Poewe W, Albrecht S, et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson’s disease: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2010; 9: 573-80.
  • 54. Sharp SI, Ballard CG, Ziabreva I, et al. Cortical serotonin 1a receptor levels are associated with depression in patients with dementia with Lewy bodies and Parkinson’s disease dementia. Dementia Geriatr Cogn Disord 2008; 26: 330-8.
  • 55. Boeve B, Silber M, Ferman T, et al. Association of REM sleep behavior disorder and neuro-degenerative disease may reflect an underlying synucleinopathy. Mov Disord 2001; 16: 622-30.
  • 56. Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2000; 123: 331-9.
  • 57. Lapierre O, Montplaisir J. Polysomnographic features of REM-sleep behavior disorder-development of a scoring method. Neurology 1992; 42: 1371-4.
  • 58. Boeve BF, Silber MH, Ferman TJ. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003; 4: 281-4.
  • 59. Larsson V, Aarsland D, Ballard C, et al. The effect of memantine on sleep behaviour in dementia with Lewy bodies and Parkinson’s disease dementia. Int J Psychogeriatr 2010; 25: 1030-8.
  • 60. Adler CH, Caviness JN, Hentz JG, et al. Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson’s disease. Mov Disord 2003; 18: 287-93.
  • 61. Hogl B, Saletu M, Brandauer E, et al. Modafinil for the treatment of daytime sleepiness in Parkinson’s disease: a double-blind, randomized, crossover, placebo-controlled polygraphic trial. Sleep 2002; 25: 905-9.
  • 62. Prado E, Paholpak P, Ngo M, et al. Agitation and psychosis associated with dementia with Lewy bodies exacerbated by modafinil use. Am J Alzheimers Dis Other Demen 2012; 27; 468-73.
  • 63. Boeve B, Kuntz K, Drubach D, et al. Safety, tolerability, and efficacy of armodafinil therapy for hypersomnia associated with dementia with Lewy bodies. Mov Disord 2012; 27(Suppl. 1): 62.
 
Source
< Prev   CONTENTS   Source   Next >