2015/05/28 by Brendon Boot · 2 citations
Medicine · Psychology · #Parkinson's Disease Mechanisms and Treatments #Ginkgo biloba and Cashew Applications #Cholinesterase and Neurodegenerative Diseases #Dementia with Lewy bodies #Rivastigmine #Dementia #Medicine #Lewy body #Synucleinopathies #Parkinson's disease #REM sleep behavior disorder #Parkinsonism #Disease #Psychiatry #Psychology #Intensive care medicine #Donepezil #Internal medicine #Alpha-synuclein
paper · pdf · doi:10.1186/s13195-015-0128-z
openalex publication_date 2015/05/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
Dementia with Lewy bodies is an under-recognized disease; it is responsible for up to 20 % of all dementia cases. Accurate diagnosis is essential because the management of dementia with Lewy bodies is more complex than many neurodegenerative diseases. This is because alpha-synuclein, the pathological protein responsible for dementia with Lewy bodies (and Parkinson's disease), produces symptoms in multiple domains. By dividing the symptoms into cognitive, neuropsychiatric, movement, autonomic, and sleep categories, a comprehensive treatment strategy can be achieved. Management decisions are complex, since the treatment of one set of symptoms can cause complications in other symptom domains. Nevertheless, a comprehensive treatment program can greatly improve the patient's quality of life, but does not alter the progression of disease. Cholinesterase inhibitors are effective for cognitive and neuropsychiatric symptoms; rivastigmine has the widest evidence base. Special care needs to be taken to avoid potentially fatal idiopathic reactions to neuroleptic medications; these should be used for short periods only when absolutely necessary and when alternative treatments have failed. Pimavanserin, a selective serotonin 5-HT2A inverse agonist, holds promise as an alternative therapy for synuclein-associated psychosis. Levodopa/carbidopa treatment of parkinsonism is often limited by dopa-induced exacerbations of neuropsychiatric and cognitive symptoms. Autonomic symptoms are under-recognized complications of synucleinopathy. Constipation, urinary symptoms and postural hypotension respond to standard medications. Rapid eye movement sleep behavior disorder is highly specific (98 %) to the synucleinopathies. Nonpharmacological treatments, melatonin and clonazepam are all effective.