Rivastigmine Shows Benefit in Dementia with Lewy Bodies - May 15, 2001 - American Academy of Family Physicians Dementia associated with Lewy bodies accounts for up to 25 percent of dementia presentations in the elderly. This form of dementia is characterized by fluctuating cognitive impairment, attention deficit, delusions, depression, parkinsonism, sleep disturbance, and visual and auditory hallucinations. Many of these features would normally be treated with neuroleptic drugs, as in patients with Alzheimer's disease, but these agents can produce a fatal reaction in patients with this type of dementia. In clinical trials, patients with this form of dementia have responded better than patients with Alzheimer's disease to therapy with cholinesterase inhibitors. This finding may be explained by the relatively greater deficiency of choline acetyltransferase and the better preservation of postsynaptic muscarinic receptors in Lewy-body dementia. McKeith and colleagues studied the efficacy, tolerability and safety of a 20-week course of therapy with rivastigmine, a cholinesterase inhibitor, in patients selected by the clinical probability of dementia with Lewy bodies. Managing patients with dementia or, more often, helping families support patients through the process, seems to be beset with paradoxes. Natural desire to do as much as possible to preserve functioning during these last precious years is tempered with the horror of adding drug side effects to the symptom burden. The prospect of false, but expensive, hope raised by some treatments can be an even worse burden. This study appears to demonstrate real benefit for the patients and their families, if the medication is tolerated and taken over a sustained period. The theoretic danger of increased parkinsonian features did not occur, and the relief of psychotic symptoms must have been particularly welcome.
