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Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD - Page 3

Medications to Treat Behavioral Problems in LBD

Medications called cholinesterase inhibitors, developed for treating Alzheimer’s disease, are used for treating LBD’s cognitive symptoms and, for some people with LBD, reducing behavioral symptoms as well. Cholinesterase inhibitors increase brain levels of acetylcholine, a chemical important for memory and learning. In LBD and other dementias acetylcholine is in short supply. Having more acetylcholine in the brain improves attention and alertness and may lessen behavioral symptoms like hallucinations.

There are three cholinesterase inhibitors currently available: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). While these drugs have been approved by the U.S. Food and Drug Administration to treat dementia in Alzheimer’s disease, only rivastigmine has been approved to treat Parkinson’s disease dementia (one of the LBDs). It is not clear if one of these medications is better for people with LBD than the others. They all improve cognitive and behavioral symptoms and usually do not significantly increase symptoms of parkinsonism. However, in one study of Parkinson’s disease dementia, a disorder very similar to dementia with Lewy bodies, rivastigmine was associated with a mild increase in tremor in some patients.  These medications can have some side effects (most commonly gastrointestinal upset) and may not help behavioral problems in all people with LBD. However, these medications can be a good first choice to treat behavioral symptoms.  It is important to note that the use of cholinesterase inhibitors is a long-term treatment strategy for behavioral symptoms and benefits are not immediately observed.

What To Do When Symptoms Do Not Go Away

Cholinesterase inhibitors do not always help behavioral symptoms. And sometimes reassurance and distraction do not work. What options are available for people with LBD who still have hallucinations or are aggressive? The answer depends on the type and severity of behavioral symptoms.

If a person’s hallucinations are not disturbing, or if they are not in danger harming themselves or others, then it may be better to not treat them. However, if the hallucinations are very disturbing or if there is a fear that the person may hurt themselves or others, then additional help is needed.

The best place to go for help is the physician who regularly treats the person’s LBD symptoms, usually a neurologist. This physician is familiar with the history of the person’s illness, what medications he or she is currently taking, and how he or she reacted to other medications in the past.  For cases where behavioral problems are especially difficult to manage, even for a neurologist, consultation with a geriatric psychiatrist is recommended.