Dementia with Lewy bodies is the second most common type of dementia after Alzheimer’s disease, comprising between 15-20% of all dementia diagnoses.
Also known as Lewy body dementia, it is caused by clumps of protein in the brain called Lewy bodies. People with dementia with Lewy bodies share many of the same symptoms of Alzheimer’s disease and Parkinson’s disease, including cognitive issues such as memory loss, problem-solving, and speech problems, and movement concerns including lack of coordination, frequent falls, and tremors. Medications and therapies such as occupational therapy, speech therapy, and psychological therapy can help treat disease symptoms.
Now, researchers from the Karolinska Institute in Sweden have found that Alzheimer’s disease medications called cholinesterase inhibitors may help slow down cognitive decline in people with dementia with Lewy bodies over five years.
In this new study published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, scientists also reported that the use of cholinesterase inhibitors was linked with a reduced mortality risk in the first year after a Lewy body dementia diagnosis. For this study, researchers analyzed data from more than 1,000 people diagnosed with dementia from Lewy bodies from the Swedish Registry on cognitive/dementia disorders.
All study participants were prescribed one of two common treatments for Alzheimer’s disease or no treatment at all. The first treatment was a cholinesterase inhibitor called donepezil, and the second treatment was memantine.
Memantine is prescribed to treat memory loss, which is a primary symptom of Alzheimer’s disease. Alzheimer’s disease negatively impacts nerve cells, causing them to create too much of a chemical called glutamate. Memantine blocks the effects of too much glutamate, offering protection to nerve cells.
However, this mortality effect was not sustained after one year in participants with dementia with Lewy bodies. Our results highlight the potential benefits of cholinesterase inhibitors for patients with dementia with Lewy bodies and support updating treatment guidelines. Because there are no FDA approved medications for Lewy body dementia, many medical providers have needed to go for off label prescription management of the condition which has included cholinesterase inhibitors. I’ve seen them help many of my Lewy body patients and in some cases they seem even more helpful than in Alzheimer’s disease, the diagnosis they are FDA approved for.
Lewy body dementia is quite prevalent, probably the most underdiagnosed subtype of dementia and with no current FDA approved medications to slow or help manage symptoms we are in desperate need of new treatment options. The next step in this line of research would be to more closely look at the clinical population examined. Are there any other reasons that this group may have shown cognitive benefit aside from the pharmacological intervention? Specifically, lifestyle factors are most important to examine.
