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Medications

Medications can be used to relieve depression, treat agitation and hallucinations, and improve cognition and/or alertness. There is a great deal of controversy about whether or not acetylcholinesterase inhibitors may slow the rate of cognitive decline or slow the need for nursing home placement.
 
Acetylcholinesterase inhibitors: These drugs increase the level of acetylcholine in the brain, which is low in DLB. These drugs can decrease fluctuations in cognition, increase alertness, and improve memory. Examples include donepezil (Aricept), tacrine (Cognex), rivastigmine (Exelon), and galantamine (Reminyl).
 
Atypical neuroleptics: These drugs can relieve hallucinations, delusions, and agitation. They do not worsen motor symptoms as much as "typical" older neuroleptic drugs do. Examples include risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel).
 
Antidepressants: The first choice for treatment of depression in DLB is the selective serotonin reuptake inhibitors, which do not deplete acetylcholine. Examples include sertraline (Zoloft), fluoxetine (Prozac), venlafaxine (Effexor), and paroxetine (Paxil).
 
Dopamine-promoting drugs: These drugs work in various ways to increase the level of the neurotransmitter dopamine in the brain. Although low dopamine level is partly responsible for the motor symptoms of DLB, these drugs often cannot be tolerated because of the side effects. They can, for example, worsen hallucinations. Examples include combined levodopa and carbidopa (Sinemet), which combines a dopamine precursor with a drug that maximizes its usefulness in the brain, and pramipexole (Mirapex) and ropinirole (Requip), which mimic the effects of dopamine.
 
Antioxidants: These agents counteract excess oxidation, which may contribute to the brain cell damage in DLB. Formal studies are lacking to determine their usefulness in slowing the disease progression. The only example now in widespread use is alpha-tocopherol, or vitamin E (Vita-Plus E Softgels, Vitec, Aquasol E).