There is currently no cure for Lewy body dementia, but treatments are available to help treat many of its symptoms. Drug treatments may help with cognitive symptoms, hallucinations and delusions, movement-related symptoms, and REM sleep behavior disorder.
You may also benefit from physical therapy, counseling, and changes to your home to help with everyday tasks.
Medication Options
A wide range of drugs may be used to treat Lewy body dementia. Typically, the choice of medications will be based on what symptoms you experience.
Cholinesterase inhibitors are a group of drugs originally approved to help with memory loss, confusion, and problems with thinking and reasoning in Alzheimer’s disease. They may also help reduce hallucinations and delusions in Lewy body dementia, and include:
- donepezil (Aricept)
- rivastigmine (Exelon)
- galantamine (Razadyne)
Sometimes, a related drug called memantine (Namenda) is added to a cholinesterase inhibitor to help boost cognitive function in moderate to severe dementia.
For movement-related symptoms, your doctor may prescribe a Parkinson’s disease medication called carbidopa-levodopa (Sinemet, Parcopa, Stalevo). But because of serious side effects like hallucinations and delusions, this drug must be used with caution.
To treat REM sleep behavior disorder, a drug called clonazepam (Klonopin) may be taken at night. The hormone melatonin may also help, on its own or in combination with clonazepam.
To treat hallucinations, delusions, agitation, and other behavioral symptoms, your doctor may prescribe what are known as atypical antipsychotic drugs. But these drugs may cause potentially severe side effects, so they should be used at the lowest dose possible for the shortest time needed to control symptoms.
Two drugs in this category are considered to have the best safety profile for Lewy body dementia.
- clozapine (Clozaril)
- quetiapine (Seroquel)
A newer atypical antipsychotic medication called pimavanserin (Nuplazid) is approved for the treatment of Parkinson’s disease-related psychosis. One study showed that pimavanserin could be effective for the treatment of several types of dementia-related psychosis, including psychosis due to Lewy body dementia.
Traditional (typical) antipsychotic medications can be dangerous for people with Lewy body dementia and should not be used. These drugs can cause severe fever, extreme movement-related symptoms, sedation, and even death.
Other Therapies
Sometimes, people with Lewy body dementia may benefit from non-drug therapies to address certain issues, such as:
- Physical therapy, to help improve strength, flexibility, and walking
- Speech therapy, to improve poor enunciation, low voice volume, or swallowing difficulties
- Occupational therapy, to help maintain skills and independence
- Individual or family psychotherapy, to help manage emotions and behavioral symptoms
- Support groups, to get emotional support and share practical advice
While antipsychotic drugs may be needed in some cases to help control hallucinations and delusions in Lewy body dementia, they can also worsen cognitive symptoms. For this reason, it’s often best to try other approaches first, such as:
- Tolerating hallucinations, if they don’t disturb the person
- Reducing clutter and noise, which can cause distress
- Offering reassurance and validating the person’s concerns
- Avoiding correcting or quizzing the person
- Keeping tasks simple and focusing on small successes
- Following routines and structure throughout the day
Complementary and Integrative Therapies
In addition to mainstream drug and non-drug therapies, people with Lewy body dementia may benefit from other practices such as:
- Music therapy or aromatherapy, to reduce anxiety and improve mood
- Pet therapy, to help improve behavior and mood
- Massage therapy, to reduce muscle tension and improve mood