Advances in the pharmacotherapeutic management of dementia with Lewy bodies

ABSTRACT

Introduction: Dementia with Lewy bodies (DLB) is the second most common type of dementia in people over 65 years of age. Given the complex clinical phenotype, the management of DLB may be challenging, especially considering that there is limited evidence about specific interventions, and there are currently no Food and Drug Administration (FDA)/European Medicines Agency (EMA)-approved medications.

Areas covered: This article provides an overview of the current pharmacotherapy in DLB and gives review to the most recent drug candidates in clinical trials.

Expert opinion: Commonly prescribed drugs are primarily aimed at treating the most troublesome clinical features of DLB. Although these medications provide some benefit to symptoms, there is, unfortunately, a lack of DLB-specific evidence on effective treatments and their off-label use. Indeed, most treatments used come from clinical trials on patients with Alzheimer’s disease or Parkinson’s disease. Thus, there is an urgent need for randomized clinical trials in DLB patients. Despite several challenges, potential new drugs are in ongoing clinical trials; furthermore, as our understanding of molecular and cellular mechanisms underlying DLB broaden, it is likely that we will identify novel drug targets for the development of better and more effective symptomatic products and disease-modifying therapies.

KEYWORDS:

• Antipsychotics
• cholinesterase inhibitors
• clinical trials
• dementia with Lewy bodies
• Parkinson’s disease dementia
• treatment

Article Highlights

• To date, there are no drugs with disease-modifying effects in DLB.

• Treatment is mostly symptomatic, but few randomized controlled trials have been conducted in DLB patients.

• The complex picture of DLB and the high risk of adverse reactions to medications complicate its management.

• Interesting recent trials on pimavanserin and zonisamide suggest the potential benefits of these drugs in DLB patients, and other candidate treatments are currently under investigation.

• The increased understanding of additional molecular alterations in the pathogenesis of DLB may pave the way for the discovery and development of new treatments in DLB.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This manuscript was not funded.