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 Treatment of PDD and DLB - A Literature Review 
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Treatment of PDD and DLB - A Literature Review
This set of authors writes a lot of medical journal articles and materials for laypeople on dementia. This recently-published article is a review of what is known about pharmacological treatment of DLB and PDD. The abstract provides a good summary. I've copied it below.

Drugs & Aging. 2011 Oct 1;28(10):769-77.

Treatment of dementia with lewy bodies and Parkinson's disease dementia.

Ballard C, Kahn Z, Corbett A.
Kings College London, London, UK.

Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) account for 10-15% of late onset dementias. Key treatment targets include cognitive and functional impairments, neuropsychiatric symptoms including intense and persistent visual hallucinations, and parkinsonism.

Six-month, placebo-controlled randomized controlled trials (RCTs) of the cholinesterase inhibitor rivastigmine have indicated modest but significant benefits in cognition, function, global outcome and neuropsychiatric symptoms in both PDD and DLB. The evidence base for other cholinesterase inhibitors from RCTs is inconclusive.

More recent RCTs with memantine in PDD/DLB patients indicate a benefit with regard to global outcome, with some suggestion of a specific benefit with respect to sleep disturbance.

Given the risk of severe antipsychotic sensitivity reactions, antipsychotics should be avoided.

A significant proportion of PDD/DLB patients are responsive to levodopa, but care needs to be taken with anti-parkinsonian treatments because of their potential propensity to exacerbate neuropsychiatric symptoms, particularly hallucinations.

PubMed ID#: 21970305 (see for this abstract only)

Tue Oct 11, 2011 4:35 pm

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Treatment of PDD and DLB - A Literature Review
Our experience certainly reflects the results of this study, Robin. Thanks for posting it. One question I have about the rivastigmine is whether or not late-stage LBD is benefited by it at all.

Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.

Tue Oct 11, 2011 5:29 pm

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Treatment of PDD and DLB - A Literature Review
I'd have to look but my guess is that the studies of rivastigmine (Exelon) in DLB and all the studies of AChEIs in Alzheimer's Disease are will early or middle-stage dementia patients. It would be very hard for late-stage patients to take some test of cognition/memory (such as the MMSE or MoCA). And I doubt anyone would predict that we'd see improvement on ADLs (another measure of efficacy in the AChEIs) in late-stage dementia patients.

Sat Oct 15, 2011 7:36 pm
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