title: Cholinesterase inhibitors in advanced Dementia with Lewy bodies: increase or stop?
abstract: BACKGROUND
  There is little data on stopping cholinesterase inhibitors in Dementia with Lewy bodies (DLB). Equally, it is not known if increasing the dose of cholinesterase inhibitors may help neuropsychiatric symptoms in advanced DLB.
  
  
  METHODS
  We conducted an open label trial with donepezil involving 16 patients with LBD when the dose was reduced and treatment stopped over 4 weeks. Another 7 patients were given a trial of an increased dose of donepezil (15 mg) to resolve rehyphen;emergent neuropsychiatric symptoms.
  
  
  RESULTS
  The slow discontinuation protocol was well tolerated in advanced DLB. Five of the seven patients given a trial of a higher dose of donepezil were rated as clinically improved after 12 weeks treatment.
  
  
  CONCLUSIONS
  Cholinesterase inhibitors can be discontinued slowly in advanced DLB. Increasing the dose of donepezil may be of benefit to some patients with DLB who experience a recurrence in their neuropsychiatric symptoms.
authors.affiliation: Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, UK.
authors.forename: Sanjeet
authors.initials: S
authors.lastname: Pakrasi
authors.forename: Alan
authors.initials: A
authors.lastname: Thomas
authors.forename: Urs P
authors.initials: UP
authors.lastname: Mosimann
authors.forename: David A
authors.initials: DA
authors.lastname: Cousins
authors.forename: Debbie
authors.initials: D
authors.lastname: Lett
authors.forename: David J
authors.initials: DJ
authors.lastname: Burn
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
authors.forename: Ian G
authors.initials: IG
authors.lastname: McKeith
mesh_terms: D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D000077265:Donepezil; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007189:Indans / Q000008:administration & dosage*; D020961:Lewy Body Disease / Q000150:complications / Q000188:drug therapy*; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D010880:Piperidines / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil