Non-pharmacological interventions for Lewy body dementia: a systematic review

Abstract

Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.

Parkinson's Disease Dementia and Lewy Body Disease

“…Nonpharmacological interventions include education of both the patient and the family, physical and mental exercise, physical therapy, and environmental modification for visual hallucinations. [31][32][33] A recent review on nonpharmacological interventions in DLB, however, did not specify any firm recommendations. 31…”

“…[31][32][33] A recent review on nonpharmacological interventions in DLB, however, did not specify any firm recommendations. 31…”

Dementia with Lewy Bodies and Parkinson's Disease-Dementia: Current Perspectives

“…Bilateral deep brain stimulation of the nucleus basalis of Meynert for PDD showed no improvement in primary cognitive outcomes [133]. A recent review of nonpharmacological interventions did not offer any definite recommendations [134]. Future therapeutic strategies might include disease-modifying methods, based on vaccination trials against αSyn, Aβ and tau proteins [135,136], inhibition of αSyn aggregation or promoting degeneration, prevention of cell-to-cell transmission of pathological αSyn, deep brain stimulation of the cholinergic nucleus basalis of Meynert or transcranial current stimulation [137,138].…”

How does epilepsy impact the pharmacotherapeutic management of patients with dementia with Lewy bodies?

“…Additionally, the disease is characterized by mild cerebral atrophy with a specific pattern in the prodromal phase (affecting the limbic structures predominantly and the insula in particular) [8]. The symptomatic treatment of DLB requires non-pharmacological approaches that are not within the scope of this paper [9]. On the other hand, the following pharmacotherapeutic options are indicated: cholinesterase inhibitors (ChEI; i.e., rivastigmine or donepezil) for cognitive decline and/or hallucinations, L-DOPA for parkinsonism, atypical neuroleptics or pimavanserin for hallucinations and/or psychosis, specific serotonin uptake inhibitors (SSRI) for depression and/or agitation, and melatonin or clonazepam for REM-sleep behavior disorder [10].…”