Swanberg and Cummings outlined therapeutic options for a patient with Dementia with Lewy Bodies (DLB) based on symptomatic presentation. The authors are from UCLA.
Symptoms to consider:
(1) cognitive impairment
(2) Parkinsonism
(3) depression
(4) hallucinations, psychosis
Symptom
First-Line Therapy
cognitive impairment
cholinesterase inhibitor
Parkinsonism
levodopa
depression
SSRI antidepressant
hallucinations, psychosis
cholinesterase inhibitor
If the Parkinsonism does not respond to levodopa or if there are significant adverse effects, then consider therapy with one of the following:
(1) a dopamine agonist
(2) levodopa plus a catechol-O-methyltransferase (COMT) inhibitor
If the hallucinations or psychosis are not controlled by the cholinesterase inhibitor, then:
(1) consider therapy with an atypical neuroleptic (clozapine, olanzapine, resperidone)
(2) if therapy is started, then use the lowest dose possible and monitor the patient very closely for signs of adverse effects so that therapy can be discontinued immediately
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