Document Detail


Dementia with lewy bodies: therapeutic opportunities and pitfalls.
MedLine Citation:
PMID:  16934009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To review diagnoses and challenges of treating patients with dementia with Lewy bodies (DLB), commonly considered the second most common form of dementia. DATA SOURCES: MEDLINE, Web of Science, and International Pharmaceutical Abstracts databases were searched in January 2006 for clinical studies, case series, case studies, letters, and review articles on the treatment of DLB. Search terms included: aripiprazole, cholinesterase inhibitors, clozapine, dementia with Lewy bodies, donepezil, galantamine, Lewy body dementia, neuroleptics, olanzapine, quetiapine, risperidone, rivastigmine, tacrine, ziprasidone. Applicable articles in the English language were reviewed. The bibliographies of these articles provided additional references. STUDY SELECTION: Articles describing studies, case series, and case studies are included in this review. DATA SYNTHESIS: DLB is commonly considered the second most common form of dementia, although some experts believe vascular dementia to be the second most common form. DLB is often under-diagnosed and misdiagnosed as Alzheimer's disease or Parkinson's related dementia. The core features of dementia with Lewy bodies are cognitive decline plus at least one of the following: fluctuations in cognition, visual hallucinations, and parkinsonism. Other supportive features include: neuroleptic sensitivity, repeated falls, syncope, transient loss of consciousness, REM sleep disturbances, depression, delusions, and nonvisual hallucinations. CONCLUSION: Increased prudence with the use of neuroleptic agents is essential in DLBs because the use of these agents is associated with physical and cognitive decline and increased mortality. While neuroleptic sensitivity has been reported with the use of both typical and atypical antipsychotic medications, these medications are often necessary for the treatment of psychotic symptoms. Decreases in neuroleptic sensitivity can often be achieved by dose reductions, although neuroleptic discontinuation is sometimes necessary. Cholinesterase inhibitors may be especially useful in the treatment of DLB. Cholinergic deficits are associated with visual hallucinations, and cholinesterase inhibitors often result in resolution of hallucinations, improved cognition, and decreased behavioral disturbances.
Authors:
Anne-Lenora Henriksen; Clarke St Dennis; Stephen M Setter; John T Tran
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists     Volume:  21     ISSN:  0888-5109     ISO Abbreviation:  Consult Pharm     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-08-28     Completed Date:  2007-01-16     Revised Date:  2008-01-17    
Medline Journal Info:
Nlm Unique ID:  9013983     Medline TA:  Consult Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  563-75     Citation Subset:  IM    
Affiliation:
Columbia Basin Health Association, Othello, Washington 99301, USA. anne@wsucougars.com
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MeSH Terms
Descriptor/Qualifier:
Antiparkinson Agents / therapeutic use
Antipsychotic Agents / therapeutic use
Cholinesterase Inhibitors / therapeutic use
Humans
Lewy Body Disease / diagnosis*,  drug therapy*
Memantine / therapeutic use
Neuroprotective Agents / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antiparkinson Agents; 0/Antipsychotic Agents; 0/Cholinesterase Inhibitors; 0/Neuroprotective Agents; 19982-08-2/Memantine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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