Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis
Open accessAbstract
OBJECTIVE: The authors examined research on effects, costs, and patient and caregiver views of pharmacological management strategies for Lewy body dementia. METHOD: Studies were identified through bibliographic databases, trials registers, gray literature, reference lists, and experts. The authors used the search terms "Lewy or parkinson" and "dementia" through March 2015 and used the following inclusion criteria: participants with diagnoses of Lewy body dementia, dementia with Lewy bodies, or Parkinson's disease dementia (or participants' caregivers); investigation of pharmacological management strategies; outcome measures and test scores reported. Data extraction and quality assessment were conducted by at least two authors. Meta-analyses were conducted, and when studies could not be combined, summaries were provided. RESULTS: Forty-four studies examining 22 strategies were included in the review. Meta-analysis indicated beneficial effects of donepezil and rivastigmine for cognitive and psychiatric symptoms. Rivastigmine, but not donepezil, was associated with greater risk of adverse events. Meta-analysis of memantine suggested that it is well tolerated but with few benefits. Descriptive summaries provide some evidence of benefits for galantamine, modafinil, levodopa, rotigotine, clozapine, duloxetine, clonazepam, ramelteon, gabapentin, zonisamide, and yokukansan. Piracetam, amantadine, selegiline, olanzapine, quetiapine, risperidone, and citalopram do not appear to be effective. CONCLUSIONS: High-level evidence related to pharmacological strategies for managing Lewy body dementia is rare. Strategies for important areas of need in Lewy body dementia, such as autonomic symptoms and caregiver burden, have not been investigated, nor have the views of patients and caregivers about pharmacological strategies.
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There is evidence for beneficial effects of cholinesterase inhibitors, but not memantine, on cognition in dementia with Lewy bodies, but parkinsonism is less likely to respond to dopaminergic drugs compared to Parkinson's disease, with an increased risk of psychosis.
“There is evidence for the beneficial effects of cholinesterase inhibitors, but not memantine, on cognition 169 , but parkinsonism is less likely to respond to dopaminergic drugs compared to Parkinson's disease, with an increased risk of psychosis 170 .”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [169]
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- Authors
- Stinton, C., McKeith, I., Taylor, J.-P., Lafortune, L., Mioshi, E., Mak, E., Cambridge, V., Mason, J., Thomas, A., & O’Brien, J. T.
- Affiliations
- Durham University (GB)
- From the Department of Psychiatry, the Department of Clinical Neurosciences, and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; the Institute of Neuroscience, University of Newcastle, Newcastle, United Kingdom; and the School of Medicine, Pharmacy, and Health, Durham University, Durham, United Kingdom.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2015-08-01
- Volume
- 172
- Issue
- 8
- Pages
- 731-742
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2161016232
- Cited by
- 264
- References
- 67
- Citations by year
- 2026: 11 · 2025: 23 · 2024: 23 · 2023: 20 · 2022: 23 · 2021: 23 · 2020: 33 · 2019: 33 · 2018: 26 · 2017: 28 · 2016: 19 · 2015: 2
- FWCI
- 3.28
- Type
- journal article
- Language
- en
- Open access
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research (DTC-RP-PG-0311-12001, NF-SI-0611-10048)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- dementia with Lewy bodies, Parkinson's disease dementia, pharmacotherapy, donepezil, rivastigmine, memantine, galantamine, modafinil, levodopa, rotigotine, clozapine, duloxetine, clonazepam, ramelteon, gabapentin, zonisamide, Yokukansan, cognitive symptoms, psychiatric symptoms, adverse events, autonomic symptoms, caregiver burden
- MeSH terms
- Antidepressive Agents, Attitude to Health, Humans, Antipsychotic Agents, Treatment Outcome, Caregivers, Excitatory Amino Acid Antagonists, Neuroprotective Agents, Nootropic Agents, Lewy Body Disease
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