A palliative care approach to LBD entails comprehensive symptom management to maximize quality of life for the person with LBD and the family caregiver. In addition to pharmacological treatments, physical, occupational, and speech therapy may also be helpful.
Early and aggressive treatment of cognitive symptoms with cholinesterase inhibitors is supported by research data suggesting that LBD patients (specifically those with dementia with Lewy bodies) may respond better than AD patients. Cholinesterase inhibitors may help reduce psychosis and should be part of a long term treatment strategy. If additional intervention is needed, cautious trial of quetiepine or clozapine for psychosis may be warranted. There is less evidence to support the use of memantine in LBD.
Treating all sleep disorders is necessary for optimal cognitive function. Melatonin and clonzepam are suggested for treatment of REM sleep behavior disorder.
Levodopa may provide some improvement in motor function and is the safest of the dopaminergic drugs. Dopamine agonists are more likely to cause psychiatric and behavioral side effects.
IMPORTANT NOTE: Traditional, or typical, antipsychotics, such as haloperidol, fluphenazine or thioridazine should be avoided. About 60% of LBD patients experience increased Parkinson symptoms, sedation, or neuroleptic malignant syndrome (NMS). NMS is a life-threatening condition characterized by fever, generalized rigidity and muscle breakdown following exposure to traditional antipsychotics.
Other drugs to avoid in LBD:
Anticholinergics may worsen cognitive impairment and cause confusion, and hallucinations.
Benzodiazepines should be used cautiously given their risk of sedation, increasing risk of falls, and paradoxical agitation.
Inhaled anesthetics should be carefully applied at the lowest possible dose if a patient needs a surgical procedure to minimize delirium risk.
Over-the-counter (OTC) sleep agents and bladder-control medications may cause agitation.
For additional information:
- Read the expanded handout: Treatment
- Read Emergency Room Treatment of Psychosis