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More evidence needed on pharmacologic treatment of Lewy body dementia

The evidence base for pharmacologic strategies for Lewy body dementia is lacking, according to a meta-analysis in the American Journal of Psychiatry.

“While a range of pharmacological strategies are used in an attempt to ameliorate the symptoms of Lewy body dementia, and while clinical guidelines have recommended cholinesterase inhibitors for cognitive and psychiatric symptoms, the current evidence for management options for the range of symptoms is limited, and there remains no unified evidence-based management care pathway,” study researcher Chris Stinton, PhD, of the University of Cambridge, in Cambridge, United Kingdom, and colleagues wrote.

Researchers analyzed 44 studies examining 22 pharmacologic strategies for Lewy body dementia or Parkinson’s disease dementia.

Results suggested that donepezil and rivastigmine were effective in treating cognitive and psychiatric symptoms, although rivastigmine was associated with a greater risk for adverse events. Memantine was well-tolerated but had few benefits, according to a meta-analysis.

Researchers found some evidence that galantamine, modafinil, levodopa, Neupro (rotigotine, UCB), clozapine, duloxetine, clonazepam, ramelteon, gabapentin, zonisamide and yokukansan had efficacy for Lewy body dementia or Parkinson’s disease dementia.

Piracetam, amantadine, selegiline, olanzapine, quetiapine, risperidone and citalopram did not appear to be effective, according to study findings.

“In this comprehensive review of pharmacological management strategies for [dementia with Lewy bodies] and [Parkinson’s disease dementia], we have identified the current best evidence for many key areas of need. There remain substantial gaps in our knowledge of patient and caregiver experiences, of cost-effectiveness, of how, when and with whom strategies should be implemented and of how meaningfully the results of studies translate to clinical practice.” – by Amanda Oldt

Disclosure: Stinton reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.