Dementia with Lewy bodies. Review of diagnosis and pharmacologic management.

OBJECTIVE To review clinical features of dementia with Lewy bodies (DLB) and to guide family physicians in pharmacologic management, including medications to avoid. QUALITY OF EVIDENCE A MEDLINE: search of literature from 1995 to 2002 used the MeSH terms dementia with Lewy bodies/diagnosis, dementia with Lewy bodies/therapy, and antipsychotics/dementia with Lewy bodies. Level II and III evidence was available for diagnosis and treatment of DLB. One randomized controlled trial of rivastigmine was reviewed and appraised. MAIN MESSAGE Dementia with Lewy bodies is common. Diagnosis can be made by family physicians using clinical criteria including presence of dementia with marked fluctuation in performance, hallucinations, and the onset of parkinsonism. Cholinesterase inhibitors should be considered for neuropsychiatric symptoms. Levodopa-carbidopa combinations should be considered for treatment of parkinsonism. Neuroleptics should be used with caution because of the risk of serious sensitivity reactions. If they are needed, atypical agents could be safer. CONCLUSION Recognition and diagnosis of DLB is important to optimize pharmacologic management and to minimize risk of adverse reactions to neuroleptics.