Medical Treatment

Drug treatment is the mainstay of therapy for DLB. The treatment of DLB is much like that of Alzheimer disease or Parkinson disease.
 
Acetylcholinesterase inhibitors (see Medication) may decrease confusion and cognitive fluctuations in DLB. These drugs generally do not worsen motor symptoms. These drugs also may be used for treatment of agitation and hallucinations associated with DLB. (When these symptoms are mild, however, no medical treatment may be necessary.)
 
An atypical neuroleptic (antipsychotic) drug typically is the first choice for treatment of hallucinations and agitation. Treating these symptoms is especially important because they can result in unsafe behavior, accidents, and injuries. Standard antipsychotic drugs such as haloperidol (Haldol) should be avoided because many people with DLB are extremely sensitive to these drugs.
 
Drugs that increase levels of the neurotransmitter dopamine are widely used to relieve the motor symptoms of Parkinson disease. These drugs may improve motor function in some people with DLB. In many people, however, these drugs have no effect and may make cognitive symptoms worse, especially hallucinations.
 
Depression is very common in DLB and may result from brain damage and/or as a psychological response to impaired function. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice. Another type of antidepressant called a monoamine oxidase-B inhibitor (MAOI) has been tried, alone or in combination with SSRIs or tricyclic antidepressants. Such combinations are not usually recommended because they can have severe side effects, especially in older people.
 
Some research studies have suggested that vitamin E, an antioxidant, may slow the rate of progression of Alzheimer diseases. Therefore, vitamin E has been tried in DLB. We do not yet have proof that this agent works in DLB.