Ask the Expert: Why Can’t All People with LBD Take the Same Medications?

Joe Friendman, MD

Q: Why can’t all people with LBD take the same medications?

A: Understanding treatment response first requires you understand the difference between treating the disease process and treating the symptoms. LBD has an unknown cause. Something, perhaps due to an inherited abnormality and/or some toxic substance or organism, causes brain cells to deteriorate and die. The dying cells make weaker and weaker connections until they stop functioning completely and then disappear. This is the disease process in LBD. We don’t understand why only particular brain cells get sick and then die. The loss of these cells causes the symptoms of LBD, such as memory loss, hallucinations, depression and motor problems like those in Parkinson’s disease.

In any disorder, the main reason doctors prescribe medications is to either alter the course of the disease or to improve the symptoms. The medications available right now for LBD only treat the symptoms. We still don’t know how to stop or slow down the disease process. This is, unfortunately, also the best we’ve been able to do in many other disorders. This is especially true for Parkinson’s disease and Alzheimer’s disease, the two most common neurodegenerative disorders.

All drugs have the potential for side effects, no matter what the disease. So if a medication is not effective in improving the symptom, the dose should either be increased to an effective level or the drug should be stopped. It is important to understand that in LBD, improvement does not mean a return to normality. It means the symptom is now better than it was without the drug.

Each LBD patient has a different set of symptoms, a different ability to tolerate a drug without side effects, a different response to any drug, and, equally important, a different need for symptomatic treatment. This means each patient’s treatment must be highly individualized. It is not uncommon to see patients who look the same in terms of their symptoms, but one is most upset with his cognitive problems while the next is more concerned with his slowness and shuffling gait and the third is more bothered by frequent lightheadedness. People are unique. Their illnesses are unique to them. One size does not fit all. To learn the basics about LBD symptom treatment, visit

Joseph H. Friedman, MD is the Director, Movement Disorders Program at Butler Hospital in Providence, RI and is a neurology professor at the Alpert Medical School of Brown University.