After a diagnosis, one of the first questions people and families often ask is what Lewy body dementia treatment is available.
There is currently no cure for Lewy body dementia (LBD), and no treatment has been proven to stop or reverse the disease. However, several medications, therapies and practical approaches can help manage particular symptoms and support quality of life.
Because LBD can affect thinking, movement, sleep, mood, behavior and automatic body functions, treatment usually needs to be individualized. A medication that helps one symptom can sometimes make another symptom worse.
For this reason, people with LBD should ideally work with a healthcare professional who understands the condition and its unusual medication sensitivities.
Lewy Body Dementia Treatment: What Are the Main Options?
A comprehensive treatment plan may include medications, physical therapy, occupational therapy, speech-language therapy, counseling, exercise, changes to the home and support for family caregivers.
Treatment depends on which Lewy body dementia symptoms are causing the greatest difficulty.
The National Institute on Aging explains that LBD treatment generally focuses on managing symptoms rather than treating the underlying disease itself.
Medications Used in Lewy Body Dementia Treatment
Medication needs to be selected carefully in LBD because people with the condition can be particularly sensitive to certain drugs.
Never start, stop or change prescription medication without discussing it with the person’s healthcare professional.
Cholinesterase Inhibitors for Cognitive Symptoms
Cholinesterase inhibitors are medications originally developed to treat symptoms of Alzheimer’s disease.
Examples include donepezil, rivastigmine and galantamine.
These medications act on acetylcholine, a brain chemical involved in memory and thinking. In people with LBD, they may help with cognitive symptoms and can sometimes also reduce hallucinations or other behavioral symptoms.
In the United States, the FDA has approved rivastigmine for cognitive symptoms associated with Parkinson’s disease dementia. Other cholinesterase inhibitors may be used by clinicians for LBD depending on the person’s circumstances.
Possible side effects can include nausea, diarrhea and dizziness.
Treatment response varies, so the person’s doctor will consider whether the benefits outweigh any side effects.
Memantine
Memantine is another medication originally developed for Alzheimer’s disease.
Some healthcare professionals may consider memantine for people with Lewy body dementia, particularly when cognitive impairment has become more significant.
However, research results in LBD have been mixed, and memantine is not FDA-approved specifically for Lewy body dementia.
The decision to use it should therefore be individualized and discussed with a doctor experienced in dementia care.
Levodopa for Movement Problems
People with LBD may develop Parkinson’s-like movement symptoms such as stiffness, slow movement, difficulty walking and trouble getting out of a chair or bed.
Levodopa, commonly used for Parkinson’s disease, may improve some of these symptoms.
This can be particularly relevant for people with Parkinson’s disease dementia.
However, levodopa can sometimes worsen hallucinations, confusion or other psychiatric symptoms in people with LBD.
For this reason, doctors may avoid treating very mild movement symptoms with medication. If levodopa is considered appropriate, treatment is generally introduced cautiously and monitored closely.
Treatment for Depression and Anxiety
Depression and anxiety are relatively common in people with LBD.
A doctor may consider antidepressant medication if these symptoms significantly affect the person’s quality of life.
The National Institute on Aging notes that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may work well for some people with LBD.
You can read more about depression and dementia on ReaDementia.
Counseling and psychological support may also be valuable, particularly after a new diagnosis or when the person and family are adapting to changes in independence.
Treatment for REM Sleep Behavior Disorder
Sleep disorders are an important part of LBD care.
One characteristic problem is REM sleep behavior disorder, in which a person may physically act out dreams by talking, kicking, punching or moving while asleep.
A doctor may recommend melatonin or, in some circumstances, low-dose clonazepam.
Clonazepam can cause problems such as dizziness, unsteadiness and worsening thinking, so it needs careful medical supervision.
A sleep specialist may also investigate other problems such as sleep apnea, restless legs syndrome or excessive daytime sleepiness.
Good daytime activity and reducing long or frequent daytime naps may also help some people sleep better at night.
Read more about dementia and sleep problems.
Hallucinations and Antipsychotics: An Important LBD Warning
Hallucinations are common in Lewy body dementia.
If hallucinations are not frightening or dangerous, medication may not always be necessary.
Sometimes reassurance, reducing stress, changing the environment or redirecting the person’s attention can be enough.
Cholinesterase inhibitors may also reduce hallucinations in some people.
However, treatment becomes more complicated when hallucinations, delusions or agitation create significant distress or safety concerns.
People with Lewy body dementia can have severe reactions to antipsychotic medications.
These reactions may include dramatically increased confusion, severe sleepiness, worsening Parkinson’s-like symptoms, low blood pressure and fainting.
Traditional antipsychotics such as haloperidol should generally be avoided in people with LBD because they can cause dangerous reactions.
Other antipsychotics, including olanzapine and risperidone, may also cause significant problems and are generally avoided where possible.
In situations where an antipsychotic is considered necessary, specialists may sometimes use medications such as quetiapine or clozapine. These decisions require careful medical supervision, with the lowest effective dose used for as short a time as practical.
A rare but potentially life-threatening reaction called neuroleptic malignant syndrome can also occur. Symptoms can include high fever and severe muscle rigidity.
If these symptoms develop after starting an antipsychotic medication, seek urgent medical attention.
Treating Blood Pressure, Constipation and Other Autonomic Symptoms
Lewy body dementia can affect the autonomic nervous system, which controls body functions that normally happen automatically.
These problems may include low blood pressure when standing, fainting, constipation, urinary problems and difficulty regulating body temperature.
Low blood pressure when standing is called orthostatic hypotension.
Simple approaches such as getting up slowly, elevating the legs or using compression stockings may help some people.
Increasing fluids or salt may sometimes be recommended, but this should only be done when a healthcare professional considers it appropriate because other health conditions can make increased fluid or salt intake unsuitable.
Constipation may respond to exercise, dietary changes or medications recommended by a doctor.
Bladder medications also need particular care because some can worsen confusion or cognitive symptoms in LBD.
Non-Drug Lewy Body Dementia Treatment Options
Medication is only one part of managing LBD.
The Lewy Body Dementia Association recommends a comprehensive approach that may involve several types of healthcare professionals.
Physical Therapy and Exercise
Physical therapists can help people with movement, balance, strength and walking.
Programs may include flexibility exercises, strengthening, cardiovascular activity and gait training.
Regular physical activity may also support general health, mobility and independence.
The appropriate type and intensity of exercise will depend on the person’s health and abilities.
Occupational Therapy
Occupational therapists focus on helping people continue everyday activities as safely and independently as possible.
They may help with dressing, bathing, eating, using household equipment and adapting routines.
You can learn more in our guide to occupational therapy and dementia.
An occupational therapist can also assess the home and suggest practical changes that reduce fall risk or make daily activities easier.
Speech and Language Therapy
Speech-language pathologists can help when LBD affects speech volume, communication or swallowing.
Swallowing assessment becomes particularly important if a person coughs, chokes, holds food in their mouth or repeatedly develops chest infections.
The therapist may recommend strategies to make eating and drinking safer.
Psychological Support and Counseling
Mental health professionals can help people with LBD and family members adjust to the emotional effects of the diagnosis.
Counseling may help with anxiety, depression, frustration, changing relationships and future planning.
Cognitive stimulation and other structured activities may also provide opportunities for mental and social engagement.
Music and Expressive Activities
Music and other expressive activities may provide enjoyment, social interaction and relaxation.
The National Institute on Aging notes that music or expressive arts therapists may provide meaningful activities that can reduce anxiety and improve well-being.
Activities should be chosen according to the person’s interests rather than treated as a cure or replacement for medical care.
You may also be interested in our articles about music therapy and dance therapy.
What About Vitamins and Supplements?
Vitamins and supplements are sometimes promoted as natural treatments for dementia.
However, the National Institute on Aging states that vitamins and supplements have not been extensively studied as treatments for LBD symptoms and are not recommended as Lewy body dementia treatment.
Supplements can also interact with prescription medicines.
A vitamin may still be appropriate if testing shows that a person has a specific deficiency, but that is different from using supplements to treat LBD itself.
Tell the person’s doctor about all supplements, vitamins and over-the-counter medicines they take.
Home Modifications and Safety
Although home changes do not treat the underlying disease, they can make daily life considerably safer and easier.
A dementia-friendly home may include:
- removing loose rugs and other trip hazards
- reducing unnecessary clutter
- providing good lighting
- using handrails and grab bars where appropriate
- arranging furniture to create clear walking paths
- using simple and familiar layouts
- reducing excessive noise or stimulation
These changes can be particularly important because people with LBD may experience balance problems, visual perception difficulties and fluctuations in attention.
Routines, Activities and Social Support
Simple, predictable routines can reduce unnecessary confusion and stress.
Regular times for waking, meals, activities and sleep may be helpful.
Meaningful activities can also provide enjoyment and maintain social contact.
The activity should suit the person’s abilities. A complicated task that creates frustration is unlikely to be helpful simply because it is mentally stimulating.
Support groups can be valuable for both people with LBD and caregivers.
Talking with other families who understand the condition can provide practical ideas as well as emotional support.
As the disease progresses through the Lewy body dementia stages, caregivers may also need increasing practical assistance and respite care.
Palliative Care for Lewy Body Dementia
Palliative care is not limited to the final days of life.
It focuses on symptom relief, comfort, quality of life, coordinated care and making sure treatment reflects the person’s goals and values.
According to the National Institute on Aging, palliative care can begin relatively early in LBD and continue alongside other treatments.
It can also help families with advance care planning and decisions about future support.
Building a Lewy Body Dementia Care Team
LBD often affects several different body systems, so care frequently involves more than one healthcare professional.
A care team may include:
- a primary care physician
- a neurologist or movement disorder specialist
- a physical therapist
- an occupational therapist
- a speech-language pathologist
- a mental health professional
- a pharmacist
- palliative care professionals when appropriate
If possible, include a doctor with experience treating Lewy body dementia because medication sensitivities and symptom fluctuations can make treatment more complicated than with some other dementias.
You can read more about finding an appropriate doctor for dementia.
When Should Treatment Be Reviewed?
LBD symptoms and medication responses can change over time.
Contact the healthcare team when there is a significant change, particularly after starting or changing medication.
Medical review is especially important with:
- sudden or severe confusion
- dramatically worsening hallucinations or delusions
- repeated falls or fainting
- new difficulty walking
- difficulty swallowing or repeated choking
- extreme sleepiness
- new severe stiffness
- fever or signs of infection
- significant changes after taking a new medicine
Sudden changes should not automatically be assumed to represent progression of dementia. Infection, pain, constipation, medication side effects and other medical conditions can also cause rapid deterioration.
Final Thoughts
There is currently no single Lewy body dementia treatment that can cure the disease or stop its progression.
Instead, treatment focuses on managing individual symptoms while protecting the person’s independence, safety and quality of life.
Cholinesterase inhibitors may help some cognitive and behavioral symptoms, levodopa may help movement problems, and other medications may be considered for sleep, depression or anxiety.
At the same time, medication must be used particularly carefully in LBD because some drugs, especially certain antipsychotics, can cause serious reactions.
Physical, occupational and speech therapy, appropriate exercise, psychological support, safer surroundings and caregiver support can all form important parts of a comprehensive care plan.
Treatment should be reviewed as the person’s symptoms change, and decisions should be made with a healthcare professional familiar with Lewy body dementia.
References and Further Reading
National Institute on Aging. How Is Lewy Body Dementia Treated and Managed?
