Dementia with Lewy bodies
ICD-10 G31.8 · ICD-11 6D82

What to Do When Cholinesterase Inhibitors Have Not Worked in Lewy Body Dementia with Cognitive Decline

This protocol addresses the management of Dementia with Lewy bodies (DLB) with cognitive impairment in patients who have not achieved adequate improvement with a cholinesterase inhibitor as first-line therapy.

Clinical Scenario

Dementia with Lewy bodies presenting with cognitive decline or cognitive impairment. Treatment of DLB is focused on the cognitive, psychiatric, motor, and other nonmotor symptoms that represent the core or most common features of the disorder.

Previous Treatment — Escalation Trigger

Prior line did not achieve goals

The patient received a cholinesterase inhibitor — rivastigmine or donepezil — targeting improvement in cognition, global function, and activities of daily living. This protocol is indicated when those goals have not been sufficiently met.

Next-Step Approach (Partial Overview)

The structured regimen involves a specific pharmacological agent that may be used either alone or in combination with a cholinesterase inhibitor. The complete protocol — including the full decision algorithm, sequencing, and clinical considerations — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Treatment of DLB is focused on the cognitive, psychiatric, motor, and other nonmotor symptoms that represent the core or most common features of the disorder.

The efficacy of memantine in DLB is less clear, but it is well-tolerated and may have benefits, either as monotherapy or adjunctive to a CHEI.

DOI: 10.1212/WNL.0000000000004058

View source ↗