In dementia with Lewy bodies (DLB), the affected areas of the brain control thinking, memory, vision and movement. There is evidence that cholinesterase inhibitors may help to improve some of the symptoms of DLB, including thinking skills and visual hallucinations.

There are three cholinesterase inhibitors available:

  • donepezil (Aricept)
  • rivastigmine (Exelon)
  • galantamine (Reminyl)

All of these drugs work in a similar way. So far, research has not found a difference in how effective each drug is, but some people may respond better to one drug than another or have fewer side-effects.

Cholinesterase inhibitors might be given to people with mild to moderate dementia with Lewy bodies, and doctors will continue to prescribe one of these drugs as symptoms progress, so long as it is safe and suitable to do so.

How cholinesterase inhibitors work

In dementia with Lewy bodies, nerve cells become damaged and lose their ability to communicate. Cholinesterase inhibitors work by increasing the amount of a chemical called acetylcholine, that helps messages to travel around the brain. These messages are vital to the way we move, think and remember. Cholinesterase inhibitors can reduce the symptoms of DLB for a time.

These treatments are normally given as tablets or capsules, but they are available in a liquid form too. Donepezil is also available as a tablet that dissolves on the tongue, and Rivastigmine is available in patches, where the drug is absorbed through the skin. Your doctor will discuss the most suitable form for you.

Effects of cholinesterase inhibitors

People with DLB may find that their symptoms improve by taking a cholinesterase inhibitor. This could be improvement in thinking, memory, communication or with day-to-day activities. Others may find that their condition stays the same, or that their symptoms do not worsen as quickly as they would have expected. Some people may not notice any effect at all.

As these drugs don’t stop the disease from progressing in the brain, symptoms will continue to get worse over time. However, they can help some people to function slightly better than they would do without the drug.

The most common side-effects of cholinesterase inhibitors are feeling or being sick, diarrhoea, having trouble sleeping, muscle cramps and tiredness. These effects are often mild and usually only temporary. Not everyone will experience side-effects. If you are worried about side-effects you can talk about this with your doctor.

So far memantine, a drug commonly prescribed to people with Alzheimer’s disease, has only been shown to have small benefits for people with DLB, but it may be offered to those who can’t be given donepezil or rivastigmine. Memantine does not stop the disease from progressing, but it may help with symptoms for some time.

Other treatments

Lewy bodies are also responsible for the damage that causes movement problems in Parkinson’s disease. Levodopa, a drug used to treat Parkinson’s, may also be used to treat movement problems in DLB. There is a risk this drug may provoke or worsen visual hallucinations. If this occurs, talk to your doctor. Physiotherapy may also be offered to help someone with DLB with their movement problems.

Practical steps, such as moving sharp objects away from the bed, can reduce the risk of injury during disturbed sleep. There are also drugs available that can help people who act out dreams.

Non-drug treatments, such as cognitive therapies, exercises and group activities, may also help with some of the symptoms of DLB. You can discuss your treatment options with the doctor.

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Treatments for dementia

Read more about treatments for dementia, including information on treating depression, anxiety and agitation and for information on antipsychotics.

Dementia with Lewy bodies

Information in this booklet is for anyone who wants to know more about dementia with Lewy bodies (DLB). This includes people living with DLB, their carers, families and friends.

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This information was updated in April 2020 and is due for review in April 2022. It does not replace any advice that doctors, pharmacists or nurses may give you. Please contact us if you would like a version with references.

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