LBD is a multi-system disease and typically requires a comprehensive treatment approach, meaning a team of physicians from different specialties, who collaborate to provide optimum treatment of each symptom without worsening other LBD symptoms. A comprehensive treatment plan may involve medications, physical, occupational, speech or other types of therapy, and counseling.
There are many treatments that can help with the symptoms; all medications prescribed for LBD are approved by the Food and Drug Administration to treat symptoms in other diseases, like Alzheimer’s disease and Parkinson’s disease. These medications can offer symptomatic benefits for cognitive, movement, sleep, mood and behavioral changes in LBD. There are not yet any medications that slow or stop the progression of LBD.
Medications called cholinesterase inhibitors are considered the standard treatment for cognitive symptoms in LBD. These medications were developed to treat Alzheimer’s disease. However, some researchers believe that people with LBD may be even more responsive to these types of medications than those with Alzheimer’s. These drugs sometimes help control behavior problems and hallucinations as well. Another medication that may be helpful is memantine (Namenda).
Movement symptoms may be treated with a Parkinson’s medication called carbidopa/levodopa (Sinemet), but if the symptoms are mild, it may be best to not treat them in order to avoid potential medication side effects.
If the hallucinations are not disruptive, they may not need to be treated. However, if they are frightening or create challenging behavioral changes, a physician may recommend treatment. Cholinesterase inhibitors are sometimes effective in treating hallucinations and other psychiatric symptoms of LBD. In addition, newer ‘atypical’ antipsychotic medications may be tried. Most LBD experts prefer quetiapine or clozapine when treatment is necessary for safety or quality of life concerns. Caution is required to find the lowest effective dose in this situation. A newer medication, pimavanserin, was approved to treat psychosis in Parkinson’s disease; results from another clinical trial of this medication in people with dementia and psychosis are pending.
While older ‘traditional’ antipsychotic medications such as thorazine and haloperidol are commonly prescribed for Alzheimer’s patients with disruptive behavior, these medications may cause severe side effects in those with LBD. For this reason, older traditional antipsychotic medications like haloperidol should be avoided.
WARNING: Up to 50% of LBD patients treated with any antipsychotic medication may have a severe reaction, such as worsening confusion, heavy sedation, and increased or possibly irreversible parkinsonism. If severe fever or muscle rigidity occurs, contact your doctor immediately; you may have a potentially life-threatening condition that is treated by stopping the medication.
REM Sleep Behavior Disorder (RBD)
RBD can be quite responsive to treatment, so your physician may recommend a medication like melatonin and/or clonazepam.
Special treatment considerations
Medication side effects
Speak with your doctor about possible side effects. The following drugs may cause sedation, motor impairment or confusion:
- Benzodiazepines, tranquilizers like diazepam and lorazepam
- Anticholinergics (antispasmodics), such as oxybutynin and glycopyrrolate
- Older antidepressants
- Certain over-the-counter medications, including diphenhydramine and dimenhydrinate.
- Some medications, like anticholinergics, amantadine and dopamine agonists, which help relieve parkinsonian symptoms, might increase confusion, delusions or hallucinations.
Surgery and anesthesia
Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD. People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.
Possible alternatives to general anesthesia include a spinal or regional block. These methods are less likely to result in postoperative confusion. If you are told to stop taking all medications prior to surgery, consult with your doctor to develop a plan for careful withdrawal.
Other types of treatments
- Lifestyle interventions include eating a healthy diet, exercising, and remaining socially active.
- Physical therapy includes cardiovascular, strengthening and flexibility exercises, as well as gait training.
- Speech therapy may improve low voice volume, poor enunciation, muscular strength, and swallowing difficulties.
- Occupational therapy helps maintain skills and promotes functional ability and independence.
- Music and aromatherapy may reduce anxiety and improve mood.
- Individual and family psychotherapy may be useful for learning strategies to manage emotional and behavioral symptoms and to help make plans that address individual and family concerns about the future.
- Support groups may be helpful for caregivers and persons with LBD to identify practical solutions to day-to-day frustrations and to obtain emotional support from others.