When Dementia with Lewy bodies (DLB) presents with parkinsonism, managing motor symptoms requires particular caution. The response to treatment in this setting can differ meaningfully from other parkinsonian syndromes, and therapeutic choices carry specific risks that must be weighed against the expected motor benefit.
Dementia with Lewy bodies with co-occurring parkinsonism. Parkinsonism in DLB is often less responsive to dopaminergic treatments than in Parkinson's disease, and the use of such treatments may be associated with an increased risk of psychosis — making careful patient selection and approach essential.
The protocol involves levodopa preparations, with the approach shaped by the need to avoid exacerbating psychiatric symptoms. The full selection criteria, titration strategy, and monitoring considerations are contained in the structured protocol.
DOI: 10.1212/WNL.0000000000004058
Parkinsonism is often less responsive to dopaminergic treatments in DLB than in PD and their use may be associated with an increased risk of psychosis, although some patients may benefit from levodopa preparations introduced at low doses and increased slowly to the minimum required to minimize motor disability without exacerbating psychiatric symptoms.
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