Pharmacologic therapy of dementia with Lewy bodies.
As a clinicopathologically defined entity, dementia with Lewy bodies (DLB) has overlapping features of Alzheimer's disease (AD) and Parkinson's disease (PD). Analogous characteristics of DLB offer a provisional rationale for pharmacologic therapy based on remediating cholinergic and dopaminergic deficits, respectively. However, the distinct clinical manifestations and pathophysiologic substrates of DLB pose unique therapeutic opportunities and challenges. More severe cholinergic deficits in DLB relative to AD support clinical evidence that cholinergic therapy may be particularly beneficial in DLB patients. In contrast, DLB patients are generally more sensitive to the adverse effects of antipsychotic agents, warranting caution in treating visual hallucinations and other psychotic symptoms. Similarly, parkinsonian motor signs in DLB, often manifest as rigidity and bradykinesia, may be less amenable to dopaminergic therapies than in PD. Increasing recognition of DLB as a common form of dementia in the elderly underscores the need for large-scale, placebo-controlled therapeutic trials.
Kaufer
Daniel I
DI
Department of Neurology, Alzheimer's Disease Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15243, USA.
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000503:physiopathology; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition; D003704:Dementia / Q000188:drug therapy* / Q000503:physiopathology; D015259:Dopamine Agents / Q000627:therapeutic use*; D006212:Hallucinations; D006801:Humans; D020961:Lewy Body Disease / Q000188:drug therapy* / Q000503:physiopathology; D009043:Motor Activity; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology; D017410:Practice Guidelines as Topic
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents