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Dementia with Lewy bodies

Dementia cum corporibus Lewy · Demence s Lewyho tělísky

What it is

Clumps of alpha-synuclein spread through the brain: fluctuating thinking, vivid hallucinations and Parkinson-like stiffness.

Symptoms & signs

  • Attention and alertness that swing from day to day
  • detailed visual hallucinations
  • acting out dreams (REM sleep behaviour disorder)
  • stiffness, slowness and falls
  • fainting and constipation

🚩 Get help if…

  • call 112 / 911 now Severe stiffness, fever or confusion after a new antipsychotic
  • call 112 / 911 now Sudden much worse confusion, or a fall with a head injury
  • see a doctor soon Frequent falls or fainting
  • see a doctor soon Choking on food or drink

Where it strikes

Medical treatment

  • Rivastigmine or donepezil — works better here than in Alzheimer's, still modest mixed evidence
  • Levodopa, carefully — it can worsen hallucinations mixed evidence
  • Avoid haloperidol and most antipsychotics: severe, sometimes fatal reactions trials support
  • Melatonin or clonazepam for acting out dreams mixed evidence
  • DaT scan to confirm trials support

Natural & lifestyle

  • A regular routine and good lighting
  • exercise and physiotherapy
  • treat hearing and vision problems
  • support for carers

Emerging & experimental

  • Neflamapimod (p38 inhibitor)
  • alpha-synuclein seed tests (skin, spinal fluid)
  • anti-synuclein antibodies

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Mediterranean diet and exercise — lower dementia risk in observational studies early / small studies
  • Bright-light therapy for sleep and mood — small studies in dementia early / small studies
  • Coconut oil (ketones) — anecdotal; trials in Alzheimer's were negative anecdotal / traditional

ICD codes