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Benefit-Risk Considerations in the Treatment of Dementia with Lewy Bodies

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Abstract

Dementia with Lewy bodies (DLB) is a relatively recently characterised syndrome with clinical and pathological features that distinguish it from classical Alzheimer’s disease. These characteristics include more rapid decline, spontaneous features of parkinsonism, visual hallucinations and fluctuating cognition.

This article reviews the clinical syndrome of DLB and the agents used to treat its cognitive, motor and behavioural manifestations. Benefit-risk issues regarding the treatment of DLB are discussed based upon limited randomised, controlled clinical trials with some speculative conclusions being drawn from case reports and case series.

We conclude that patients with DLB may respond better to cholinesterase inhibitors than patients with Alzheimer’s disease on both cognitive and behavioural measures. Cholinesterase inhibitor therapy may result in reduced caregiver burden and less time institutionalised. These agents are well tolerated with the majority of adverse effects being gastrointestinal in nature. Although neuropsychiatric manifestations are numerous in patients with DLB, antipsychotics should be used infrequently and with caution, although atypical antipsychotics are better tolerated than conventional antipsychotics. Physicians should exhibit caution when prescribing these agents because of the increased risk of extrapyramidal adverse effects. Limited data suggest that the use of levodopa or other dopaminergic agents may be of benefit for the treatment of the parkinsonism that is associated with DLB. However, the increased risk of hallucinations and neuropsychiatric symptoms may negate the potential benefits of increased mobility. There is insufficient evidence to draw conclusions about the use of antidepressants; however, selective serotonin reuptake inhibitors may be of benefit.

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References

  1. Kosaka K, Yoshimura M, Ikeda K, et al. Diffuse type of Lewy body disease: progressive dementia with abundant cortical Lewy bodies and senile changes of varying degree: a new disease? Clin Neuropathol 1984; 3: 185–92

    PubMed  CAS  Google Scholar 

  2. Del Ser T, McKeith I, Anand R, et al. Dementia with Lewy bodies: findings from an international multicenter study. Int J Geriatr Psychiatry 2000; 15: 1034–45

    Article  PubMed  Google Scholar 

  3. McKeith I, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996; 47: 1113–24

    Article  PubMed  CAS  Google Scholar 

  4. Londos E, Passant U, Gustafson L, et al. Neuropathological correlates to clinically defined dementia with Lewy bodies. Int J Geriatr Psychiatry 2001; 16: 667–79

    Article  PubMed  CAS  Google Scholar 

  5. Kotzbauer PT, Trojanowski JQ, Lee VM. Lewy body pathology in Alzheimer’s disease. J Mol Neurosci 2001; 17: 225–32

    Article  PubMed  CAS  Google Scholar 

  6. Lippa CF, Schmidt ML, Lee VM, et al. Alpha-synuclein in familial Alzheimer disease. Arch Neurol 2001; 58: 1817–20

    Article  PubMed  CAS  Google Scholar 

  7. Del Ser T, Hachinski V, Merskey H, et al. Clinical and pathologic features of two groups of patients with dementia with Lewy bodies: effect of coexisting Alzeimer-type lesion load. Alzheimer Dis Assoc Disord 2001; 15: 31–44

    Article  PubMed  Google Scholar 

  8. Spillantini MG, Goedert M. The alpha-synucleinopathies: Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy. Ann N Y Acad Sci 2000; 920: 16–27

    Article  PubMed  CAS  Google Scholar 

  9. McKeith I, Perry E, Perry R. Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Neurology 1999; 53: 902–5

    Article  PubMed  CAS  Google Scholar 

  10. Luis CA, Barker WW, Gajaraj K, et al. Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy verified sample. Int J Geriatr Psychiatry 1999; 14: 526–33

    Article  PubMed  CAS  Google Scholar 

  11. Mega MS, Masterman DL, Benson DF. Dementia with Lewy bodies: reliability and validity of clinical and pathologic criteria. Neurology 1996; 47: 1403–9

    Article  PubMed  CAS  Google Scholar 

  12. McKeith I, O’Brien J, Ballard C. Diagnosing dementia with Lewy bodies. Lancet 1999; 354: 1227–8

    Article  PubMed  CAS  Google Scholar 

  13. Olichney JM, Galasko D, Salmon DP, et al. Cognitive decline is faster in Lewy body variant than in Alzheimer’s disease. Neurology 1998; 51: 351–7

    Article  PubMed  CAS  Google Scholar 

  14. McKeith IG. Senile dementia of Lewy body type - a review of clinical and pathological features: implications for treatment. Int J Geriatr Psychiatry 1995; 10: 919–26

    Article  Google Scholar 

  15. Cercy SP, Bylsma FW. Lewy bodies and progressive dementia: a critical review and meta-analysis. J Int Neuropsychol Soc 1997; 3: 179–94

    PubMed  CAS  Google Scholar 

  16. Ala TA, Yank K, Sung JH, et al. Hallucinations and signs of parkinsonism help distinguish patients with dementia and cortical Lewy bodies from patients with Alzheimer’s disease at presentation: a clinicopathological study. J Neurol Neurosurg Psychiatry 1997; 62: 16–21

    Article  PubMed  CAS  Google Scholar 

  17. Walker Z, Allen RL, Shergill S, et al. Three year survival in patients with a clinical diagnosis of dementia with Lewy bodies. Int J Geriatr Psychiatry 2000; 15: 267–73

    Article  PubMed  CAS  Google Scholar 

  18. Ballard C, Holmes C, McKeith I, et al. Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer’s disease. Am J Psychiatry 1999; 156: 1039–45

    PubMed  CAS  Google Scholar 

  19. Gurd JM, Herzberg L, Joachim C, et al. Dementia with Lewy bodies: a pure case. Brain Cogn 2000; 44: 307–23

    Article  PubMed  CAS  Google Scholar 

  20. Mori E, Shimomura T, Fujimori M, et al. Visuoperceptual impairment in dementia with Lewy bodies. Arch Neurol 2000; 57: 489–93

    Article  PubMed  CAS  Google Scholar 

  21. Calderon J, Perry RJ, Erzinclioglu S, et al. Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alheimer’s disease. J Neurol Neurosurg Psychiatry 2001; 70: 157–64

    Article  PubMed  CAS  Google Scholar 

  22. Morris SK, Olichney JM, Corey-Bloom J. Psychosis in dementia with Lewy bodies. Semin Clin Neuropsychiatry 1998; 3: 51–0

    PubMed  Google Scholar 

  23. Chung JA, Cummings JL. Neurobehavioral and neuropsychiatric symptoms in Alzheimer’s disease: characteristics and treatment. Neurol Clin 2000; 18: 829–46

    Article  PubMed  CAS  Google Scholar 

  24. Ballard CG, O’Brien J, Swann A, et al. The natural history of psychosis and depression in dementia with Lewy bodies and Alzheimer’ disease: persistence and new cases over 1 year of follow-up. J Clin Psychiatry 2001; 62: 46–9

    Article  PubMed  CAS  Google Scholar 

  25. Flynn FG, Cummings JL, Gornbein J. Delusions in dementia syndromes: investigation of behavioral and neuropsychological correlates. J Neuropsychiatry Clin Neurosci 1991; 3(4): 364–70

    PubMed  CAS  Google Scholar 

  26. Hirono N, Cummings JL. Neuropsychiatric aspects of dementia with Lewy bodies. Curr Psychiatry Rep 1999; 1: 85–92

    Article  PubMed  CAS  Google Scholar 

  27. Kolbeinsson H, Jonsson A. Delirium and dementia in acute medical admissions of elderly patients in Iceland. Acta Psychiatr Scand 1993; 87: 123–7

    Article  PubMed  CAS  Google Scholar 

  28. Robertson B, Blennow K, Gottfries CG, et al. Delirium in dementia. Int J Geriatr Psychaitry 1998; 13: 49–56

    Article  Google Scholar 

  29. Litvan I, MacIntyre A, Goetz CG, et al. Accuracy of the clinical diagnosis of Lewy body disease, Parkinson disease, and dementia with Lewy bodies: a clinicopathological study. Arch Neurol 1998; 55: 969–78

    Article  PubMed  CAS  Google Scholar 

  30. Walker MP, Ayre GA, Cummings JL, et al. Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease, and vascular dementia. Neurology 2000; 54: 1616–24

    Article  PubMed  CAS  Google Scholar 

  31. Walker MP, Ayre GA, Cummings JL, et al. The clinician assessment of fluctuation and the one day fluctuation assessment scale. Br J Psychiatry 2000; 177: 252–6

    Article  PubMed  CAS  Google Scholar 

  32. Louis ED, Klatka L, Liu Y, et al. Comparison of extrapyramidal features in 31 pathologically confirmed cases of diffuse Lewy body disease and 34 pathologically confirmed cases of Parkinson’s disease. Neurology 1997; 48: 376–80

    Article  PubMed  CAS  Google Scholar 

  33. Louis ED, Goldman JE, Powers JM, et al. Parkinsonian features of eight pathologically diagnosed cases of diffuse Lewy body disease. Mov Disord 1995; 10: 188–94

    Article  PubMed  CAS  Google Scholar 

  34. Aarsland D, Ballard C, McKeith I, et al. Comparison of extrapyramidal signs in dementia with Lewy bodies and Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2001; 13: 374–9

    Article  PubMed  CAS  Google Scholar 

  35. Myllyla VV, Kultalahti ER, Haapaniemi H, et al. Twelve-month safety of entacopone in patients with Parkinson’s disease. Eur J Neurol 2001; 8: 53–60

    Article  PubMed  CAS  Google Scholar 

  36. Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA 2000; 284: 1931–38

    Google Scholar 

  37. Korczyn AD, Brunt ER, Larsen JP, et al. A 3-year randomized trial of ropinirole and bromocriptine in early Parkinson’s disease. The 053 Study Group. Neurology 1999; 53: 364–70

    Article  PubMed  CAS  Google Scholar 

  38. Lieberman A, Goodgold A, Jonas S, et al. Comparison of dopa decarboxylase inhibitor (carbidopa) combined with levodopa and levodopa alone in Parkinson’s disease. Neurology 1975; 25: 911–6

    Article  PubMed  CAS  Google Scholar 

  39. Wilkinson D, Murray J. Galantamine: a randomized, double-blind, dose comparison in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2001; 16: 852–7

    Article  PubMed  CAS  Google Scholar 

  40. Raskind MA, Peskind ER, Wessel T, et al. Galantamine USA-1 Study Group. Galantamine in AD: a 6-month randomized, placebo-controlled trial with a 6-month extension. Neurology 2000; 54: 2261–8

    Article  PubMed  CAS  Google Scholar 

  41. Corey-Bloom J, Anand R, Veach J, et al. A randomized trial evaluating the efficacy and safety of ENA (rivastigmine), a new acetycholinesterase inhibitor, in patients with mild to moderately severe Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1: 55–65

    CAS  Google Scholar 

  42. Winblad B, Engedal K, Soininen H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001; 57: 489–95

    Article  PubMed  CAS  Google Scholar 

  43. Rogers SL, Farlow MR, Doody RS, et al. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzeimer’s disease. The Donepezil Study Group. Neurology 1998; 50: 136–45

    Article  PubMed  CAS  Google Scholar 

  44. Byrne E, Lennox G, Lowe J, et al. Diffuse Lewy body disease: clinical features in 15 cases. J Neurol Neurosurg Psychiatry 1989; 52: 709–17

    Article  PubMed  CAS  Google Scholar 

  45. Geroldi C, Frisoni G, Bianchetti A, et al. Drug treatment in Lewy body dementia. Dement Geriatr Cogn Disord 1997; 8: 188–97

    Article  PubMed  CAS  Google Scholar 

  46. Hely MA, Reid WGJ, Morris JGL. Diffuse Lewy body disease: clinical features in nine cases without coexistent Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1996; 60: 531–8

    Article  PubMed  CAS  Google Scholar 

  47. Fahn S, Elton RL, and members of the UPDRS Development Committee. Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne DB, et al., editors. Recent developments in Parkinson’s disease. Florham Park (NJ): Macmillan Health Care Information, 1987: 153–63

    Google Scholar 

  48. Hoehn MH, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17: 427–42

    Article  PubMed  CAS  Google Scholar 

  49. Weiner WJ, Factor SA, Jankovic J, et al. The long-term safety and efficacy of pramipexole in advanced Parkinson’s disease. Parkinson Relat Disord 2002 Apr; 7(2): 115–20

    Article  Google Scholar 

  50. Hauser RA, Gauger L, Anderson WM, et al. Pramipexole-induced somnolence and episodes of daytime sleep. Mov Disord 2000; 15: 658–63

    Article  PubMed  CAS  Google Scholar 

  51. Pal S, Bhattacharya KF, Agapito C, et al. A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson’s disease patients taking pramipexole, cabergoline, and levodopa mono and combination therapy. J Neural Transm 2001; 108: 71–7

    Article  PubMed  CAS  Google Scholar 

  52. Tanner CM. Dopamine agonists in early therapy for Parkinson disease: promise and problems. JAMA 2000: 284: 1971–3

    Article  PubMed  CAS  Google Scholar 

  53. Levy R, Eagger S, Griffiths M, et al. Lewy bodies and response to tacrine in Alzheimer’s disease [letter]. Lancet 1994; 343: 176

    Article  PubMed  CAS  Google Scholar 

  54. Samuel W, Caligiuri M, Galasko D, et al. Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: a preliminary study. Int J Geriatr Psychiatry. 2000; 15: 794–802

    Article  PubMed  CAS  Google Scholar 

  55. Langlais PJ, Thal L, Hansen L, et al. Neurotransmitters in basal ganglia and cortex of Alzheimer’s disease with and without Lewy bodies. Neurology 1993; 43: 1927–34

    Article  PubMed  CAS  Google Scholar 

  56. Perry EK, Haroutunian V, Perry RH, et al. Neocortical cholinergic activities differentiate Lewy body dementia from classical Alzheimer’s disease. Neuroreport 1994; 5: 747–9

    Article  PubMed  CAS  Google Scholar 

  57. Shiozaki K, Iseki E, Uchiyama H, et al. Alterations of muscarinic acetylcholine receptor subtypes in diffuse Lewy body disease: relation to Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1999; 67: 209–13

    Article  PubMed  CAS  Google Scholar 

  58. Shea C, MacKnight C, Rockwood K. Donepezil for treatment of dementia with Lewy bodies: a case series of nine patients. Int Psychogeriatr 1998; 10: 229–38

    Article  PubMed  CAS  Google Scholar 

  59. Rojas-Fernandez C. Successful use of donepezil for the treatment of dementia with Lewy bodies. Ann Pharmacother 2001; 35: 202–5

    Article  PubMed  CAS  Google Scholar 

  60. Rojas-Fernandez C, MacKnight C. Dementia wth Lewy bodies: review and pharmacotherapeutic implications. Pharmacotherapy 1999; 19: 795–803

    Article  PubMed  CAS  Google Scholar 

  61. Lanctot K, Herrmann N. Donepezil for behavioural disorders associated with Lewy bodies: a case series. Int J Geriatr Psychiatry 2000; 15: 338–45

    Article  PubMed  CAS  Google Scholar 

  62. Kaufer DI, Catt KE, DeKosky ST, et al. Dementia with Lewy bodies: response of delirium-like features to donepezil [letter]. Neurology 1998; 51: 1512

    Article  PubMed  CAS  Google Scholar 

  63. Skjerve A, Nygaard H. Improvement in sundowning in dementia with Lewy bodies after treatment with donepezil. Int J Geriatr Psychiatry 2000; 15: 1147–51

    Article  PubMed  CAS  Google Scholar 

  64. McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomized, double-blind, placebo-controlled international study. Lancet 2000; 356: 2031–6

    Article  PubMed  CAS  Google Scholar 

  65. Cummings JL, Mega M, Gray K, et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–14

    Article  PubMed  CAS  Google Scholar 

  66. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98

    Article  PubMed  CAS  Google Scholar 

  67. Grace J, Daniel S, Stevens T, et al. Long-term use of rivastigmine in patients with dementia with Lewy bodies: an open-label trial. Int Psychogeriatr 2001; 13: 199–205

    Article  PubMed  CAS  Google Scholar 

  68. Reisberg B, Borenstein J, Salob SP, et al. Behavioral symptoms in Alzheimer’s disease: phenomenology and treatment. J Clin Psychiatry 1987; 48: 9–15

    PubMed  Google Scholar 

  69. Chacko RC, Hurley RA, Jankovic J. Clozapine use in diffuse Lewy body disease. J Neuropsychiatry Clin Neurosci 1993; 5: 206–8

    PubMed  CAS  Google Scholar 

  70. Burke WJ, Pfeiffer RF, McComb RD. Neuroleptic sensitivity to clozapine in dementia with Lewy bodies. J Neuropsychiatry Clin Neurosci 1998; 10: 227–9

    PubMed  CAS  Google Scholar 

  71. Allen RL, Walker Z, D’Ath PJ, et al. Risperidone for psychotic and behavioural symptoms in Lewy body dementia. Lancet 1995; 346: 185

    Article  PubMed  CAS  Google Scholar 

  72. McKeith IG, Ballard CG, Harrison RWS. Neuroleptic sensitivity trisperidone in Lewy body dementia. Lancet 1995; 346: 699

    Article  PubMed  CAS  Google Scholar 

  73. Sechi G, Agnetti V, Masuri R, et al. Risperidone, neuroleptic malignant syndrome and probable dementia with Lewy bodies. Prog Neuropsychopharmacol Biol Psychiatry 2000; 24: 1043–51

    Article  PubMed  CAS  Google Scholar 

  74. Walker Z, Grace J, Overshot R, et al. Olanzapine in dementia with Lewy bodies: a clinical study. Int J Geriatr Psychiatry 1999; 14: 459–66

    Article  PubMed  CAS  Google Scholar 

  75. Cummings JL, Street J, Masterman D, et al. Efficacy of olanzapine in the treatment of psychosis in dementia with Lewy bodies. Dement Geriatr Cogn Disord 2002. 13: 67–73

    Article  PubMed  CAS  Google Scholar 

  76. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington: American Psychiatric Association, 1994

  77. Nyth AL, Gottfries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a nordic multicentre study. Br J Psychiatry 1990; 157: 894–901

    Article  PubMed  CAS  Google Scholar 

  78. Pollock BG, Mulsant BH, Sweet R, et al. An open pilot study of citalopram for behavioral disturbances of dementia: plasma levels and real-time observations. Am J Geriatr Psychiatry 1997; 5: 70–8

    PubMed  CAS  Google Scholar 

  79. Tarango F, Lykestos C, Mangone C, et al. A double-blind, fixed dose trial of fluoxetine vs amitryptiline in the treatment of major depression complicating Alzheimer’s disease. Psychosomatics 1997; 38: 246–52

    Article  Google Scholar 

  80. Fitzpatrick R, Peto V, Hyman N, et al. Health-related quality of life in Parkinson’s disease: a study of outpatient clinic attenders. Mov Disord 1997; 12: 916–22

    Article  PubMed  CAS  Google Scholar 

  81. Olanow CW, Watts RL, Koller WC. An algorithm for the management of Parkinson’s disease. Neurology 2001; 56Suppl. 1: S1–S47

    Article  PubMed  CAS  Google Scholar 

  82. Rascol O, Brooks DJ, Brunt ER, et al. Ropinirole in the treatment of early Parkinson’s disease: a 6-month interim report of a 5-year levodopa-controlled study. Mov Disord 1998; 13: 39–45

    Article  PubMed  CAS  Google Scholar 

  83. Factor SA. Parkinson’s disease and Parkinsonian syndromes. Med Clin North Am 1999; 83: 415–43

    Article  PubMed  CAS  Google Scholar 

  84. Schrag A, Jahanshahi M, Quinn N. How does Parkinson’s disease affect quality of life?. A comparison with quality of life in the general population. Mov Disord 2000; 15: 1112–8

    Article  PubMed  CAS  Google Scholar 

  85. Bodagh I, Robertson D. A risk-benefit assessment of drugs used in the management of Parkinson’s disease. Drug Saf 1994; 11: 94–103

    Article  PubMed  CAS  Google Scholar 

  86. Wasielewski P, Koller W. Quality of life and Parkinson’s disease: the CR first study. J Neurol 1998; 245Suppl. 1: 28S–30S

    Article  Google Scholar 

  87. Wolters EC. Dopaminomimetic psychosis in Parkinson’s disease patients: diagnosis and treatment. Neurology 1999; 52Suppl. 3: S10–3

    PubMed  CAS  Google Scholar 

  88. Goetz CG, Vogel C, Tanner CM, et al. Early dopaminergic drug-induced hallucinations in parkinsonian patients. Neurology 1998; 51: 811–4

    Article  PubMed  CAS  Google Scholar 

  89. Waters C. Catechol-O-methyltransferase (COMT) inhibitors in Parkinson’s disease. J Am Geriatr Soc 2000; 48: 692–8

    PubMed  CAS  Google Scholar 

  90. Novella JL, Ankri J, Morrone I, et al. Evaluation of the quality of life in dementia with a generic quality of life questionnaire: the Duke health profile. Dement Geriatr Cogn Disord 2001; 12: 158–66

    Article  PubMed  CAS  Google Scholar 

  91. Ballard C, O’Brien J, James I, et al. Quality of life for people with dementia living in residential and nursing home care: the activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs. Int Psychogeriatr 2001; 13: 93–106

    Article  PubMed  CAS  Google Scholar 

  92. Hutchinson M, Fazzini E. Cholinesterase inhibition in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1996; 61: 324–5

    Article  PubMed  CAS  Google Scholar 

  93. Reading PJ, Luce AK, McKeith IG. Rivastigmine in the treatment of parkinsonian psychosis and cognitive impairment: preliminary findings from an open trial. Mov Disord 2001; 16: 1171–95

    Article  PubMed  CAS  Google Scholar 

  94. Markowitz JS, Brown CS, Moore TR. Atypical antipsychotics, part I: pharmacology, pharmacokinetics, and efficacy. Ann Pharmacother 1999; 33: 73–85

    Article  PubMed  CAS  Google Scholar 

  95. de Deyn P, Rabheru K, Rasmussen A, et al. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999; 53: 946–55

    Article  PubMed  Google Scholar 

  96. de Deyn P, Katz IR. Control of aggression and agitation in patients with dementia: efficacy and safety of risperidone. Int J Geriatr Psychiatry 2000; 15: S14–23

    PubMed  Google Scholar 

  97. Herrmann N, Rivard M, Flynn M, et al. Risperidone for the treatment of behavioral disturbances in dementia: a case series. J Neuropsych Clin Neurosci 1998; 10: 220–3

    CAS  Google Scholar 

  98. Katz IR, Jeste DV, Mintzer JE, et al. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. J Clin Psychiatry 1999; 60: 107–15

    Article  PubMed  CAS  Google Scholar 

  99. Rojas-Fernandez CH, Lanctot KL, Allen DD, et al. Pharmacotherapy of behavioral and psychological symptoms of dementia: time for a different paradigm? Pharmacotherapy 2001; 21: 74–102

    Article  PubMed  CAS  Google Scholar 

  100. Shigenobu K, Ikeda M, Fukuhara R, et al. Reducing the burden of caring for Alzheimer’s disease through the amelioration of ‘delusions of theft’ by drug therapy. Int J Geriatr Psychiatry 2002; 17: 211–7

    Article  PubMed  Google Scholar 

  101. Tarsy D, Baldessarini RJ, Tarazi FI. Effects of newer antipsychotics on extrapyramidal function. CNS Drugs 2002; 16: 23–45

    Article  PubMed  CAS  Google Scholar 

  102. Dewey RB, O’Suilleabhain PE. Treatment of drug-induced psychosis with quetiapine and clozapine in Parkinson’s disease. Neurology 2000; 55: 1753–5

    Article  PubMed  Google Scholar 

  103. Parsa M, Greenaway H, Bastiani M. Quetiapine in the treatment of psychosis in patients with Parkinson’s disease and dementia (Lewy body disease variant). Ann Neurol 2001, 50; S77

    Google Scholar 

  104. Targum SD, Abbott JL. Efficacy of quetiapine in Parkinson’s patients with psychosis. J Clin Psychopharmacol 2000; 20: 54–60

    Article  PubMed  CAS  Google Scholar 

  105. Hoehn-Saric R, Lipsey JR, McLeod DR. Apathy and indifference in patients on fluvoxamine and fluoxetine. J Clin Psychiatry 1994; 55: 137–41

    Google Scholar 

  106. Boyer WF, Blumhardt CL. The safety profile of paroxetine J Clin Psychiatry 1992; 53Suppl. 2: 61–66

    PubMed  Google Scholar 

  107. Grimsley SR, Jann MW. Paroxetine, sertraline, and fluvoxamine: new selective serotonin reuptake inhibitors. Clin Pharm 1992; 11: 930–57

    PubMed  CAS  Google Scholar 

  108. Muldoon C. The safety and tolerability of citalopram. Int Clin Psychopharmacol 1996; 11Suppl. 1: 35–40

    Article  PubMed  Google Scholar 

  109. Piazza LA, Markowitz JC, Locsis JH, et al. Sexual functioning in chronically depressed patients treated with SSRI antidepressants. Am J Psychiatry 1997; 154: 1757–9

    PubMed  CAS  Google Scholar 

  110. Hsu JH, Shen WW. Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients. Int J Psychiatry Med 1995; 25: 191–201

    Article  PubMed  CAS  Google Scholar 

  111. Shmuely Y, Baumgarten M, Rovner B, et al. Predictors of improvement in health-related quality of life among elderly patients with depression. Int Psychogeriatr 2001; 13: 63–73

    Article  PubMed  CAS  Google Scholar 

  112. Skevington SM, Wright A. Changes in the quality of life of patients receiving antidepressant medication in primary care: validation of the WHOQOL-100. Br J Psychiatry 2001; 178: 261–7

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This program was supported by a National Institute on Aging Alzheimer’s Disease Research Center grant (AG 16570), an Alzheimer’s Disease Research Center of California grant, and the Sidell-Kagan Foundation. Dr Cummings has provided consultation to Eisai, Pfizer, Lilly, Janssen, Novartis, Bristol-Meyers Squibb, Astra-Zeneca and Parke-Davis relevant to compounds discussed in this article.

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  1. Department of Neurology, UCLA School of Medicine, UCLA Alzheimer’s Disease Center, 710 Westwood Plaza, Los Angeles, California, CA90095-1769, USA

    Margaret M. Swanberg &  Jeffrey L. Cummings

  2. Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, California, USA

    Jeffrey L. Cummings

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Swanberg, M.M., Cummings, J.L. Benefit-Risk Considerations in the Treatment of Dementia with Lewy Bodies. Drug-Safety 25, 511–523 (2002). https://doi.org/10.2165/00002018-200225070-00005

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