Dementia With Lewy Bodies
Drugs for Dementia With Lewy Bodies continued...
Acetylcholinesterase inhibitors: These drugs increase the level of acetylcholine in the brain, which is low in DLB. These drugs can decrease fluctuations in cognition, increase alertness, and improve memory. Examples include donepezil (Aricept), tacrine (Cognex), rivastigmine (Exelon), and galantamine (Razadyne or Reminyl).
No drugs are specifically approved by the FDA to treat DLB. Nevertheless, a number of different types of psychiatric medicines may have value when used "off label" to treat symptoms associated with DLB.
Atypical antipsychotics: These drugs can relieve hallucinations, delusions, and agitation. They do not worsen motor symptoms as much as "typical" older neuroleptic drugs do. Examples include risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Antipsychotics have been linked with an increased risk for death in elderly patients with psychosis related to dementia, and require careful monitoring when used "off label" in such patients.
Antidepressants: The first choice for treatment of depression in DLB is the selective serotonin reuptake inhibitors, which do not deplete acetylcholine. Examples include sertraline (Zoloft) or fluoxetine (Prozac) and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) or duloxetine (Cymbalta).
Dopamine-promoting drugs: These drugs work in various ways to increase the level of the neurotransmitter dopamine in the brain. Although low dopamine levels are partly responsible for the motor symptoms of DLB, these drugs often cannot be tolerated because of their side effects. They can, for example, sometimes worsen hallucinations. Examples include combined levodopa and carbidopa (Sinemet), which combines a dopamine precursor with a drug that maximizes its usefulness in the brain, and pramipexole (Mirapex) and ropinirole (Requip), which mimic the effects of dopamine.
Antioxidants: These agents counteract excess oxidation, which may contribute to the brain cell damage in DLB. Formal studies are lacking to determine their usefulness in slowing the disease progression. The only example now in widespread use is alpha-tocopherol, or vitamin E (Vita-Plus E Softgels, Vitec, Aquasol E).
Next Steps for Dementia With Lewy Bodies
After DLB has been diagnosed and treatment begun, the individual requires regular check-ups with his or her health care provider.
- These check-ups allow the health care provider to monitor disease progression and see how well treatment is working, and make recommendations about both medications as well as non-medication aspects of treatment, as necessary.
- They allow detection of new medical and behavior problems that could benefit from treatment.
- These visits also give the family caregiver(s) an opportunity to discuss problems in the individual’s care.
Because DLB is a progressive disorder, eventually the person with DLB will become unable to care for himself or herself, or even to make decisions about his or her care.
- It is best for the person to discuss future care arrangements with family members as early as possible, so that his or her wishes can be clarified and documented for the future.
Your health care provider can advise you about legal arrangements that should be made to ensure that these wishes are observed.