Lewy Body Dementia (dementia with Lewy bodies and Parkinson’s Disease Dementia) involves visual hallucinations, fluctuating cognition / attention, motor disturbances, falls, and extreme sensitivity to antipsychotics. Caution in the use of pharmacological treatments such as antipsychotics is advised in recent guidelines. A systematic review investigates the effectiveness of non-pharmacological interventions for patients with Lewy Body Dementia (and / or their carers). A number of different possible interventions considered include:
- Interventions to prevent aspiration of fluids in patients with dysphagia.
- Exercise (high-intensity functional exercises).
- Exercise (stationary cycling).
- Interventions to improve gait (auditory cueing of gait with a metronome and verbal instructions).
- Physical therapy (Lee Silverman voice treatment).
- Multi-component intervention including carer education and tailored environmental modification.
- Psychological intervention for visual hallucinations, including psychoeducation and environmental modification.
- Environmental modification to reduce mirrored self-misidentification delusion (reducing the mirror size and personalising it with artwork).
- Music therapy.
- Simulated presence.
- Occupational therapy (‘skill building through task-oriented motor practice’; STOMP).
- Occupational therapy (system-based intervention focused on improving the patient’s functional abilities and carer behaviours).
- Electroconvulsive therapy (unilateral).
- Electroconvulsive therapy (bilateral).
- Electroconvulsive therapy.
- Electroconvulsive therapy (bifrontotemporal).
- Transcranial magnetic stimulation (dorsolateral prefrontal cortex bilaterally).
- Transcranial direct current stimulation.
- Deep brain stimulation (two electrodes in the nucleus basalis of Meynert; two electrodes in the subthalamic nucleus).
- Deep brain stimulation (single electrode in the left internal segment of globus pallidus).
- Deep brain stimulation (unilateral stimulation of the pedunculopontine nucleus).
No definite recommendations could be made, so more research is needed.
“Overall, given the heterogeneity of interventions, small sample sizes, and poor quality of research, no treatment recommendations can be offered”. p.1756.
Full Text Link
Connors, MH. Quinto, L. [and] McKeith, I. [et al] (2018). Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychological Medicine. August 2018; 48(11): 1749-1758.
A different systematic review on the same subject appeared slightly earlier:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Morrin, H. Fang, T. [and] Servant, D. [et al] (2018). Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia. International Psychogeriatrics. March 2018; 30(3): 395-407.