Certain Alzheimer’s disease medications may slow cognitive decline in Lewy body dementia

• There is currently no cure for dementia with Lewy bodies, which is the 2nd most common type of dementia.
• Researchers from the Karolinska Institutet have found that Alzheimer’s disease medications called cholinesterase inhibitors may help slow down cognitive decline in people with dementia with Lewy bodies over five years.
• Scientists also report that the use of cholinesterase inhibitors was linked with a reduced mortality risk in the first year after a Lewy body dementia diagnosis.

Dementia with Lewy bodies is the second most common type of dementia after Alzheimer’s disease, comprising between 15-20% of all dementia diagnoses.

Also known as Lewy body dementia , it is caused by clumps of protein in the brain called Lewy bodies. People with dementia with Lewy bodies share many of the same symptoms of Alzheimer’s disease and Parkinson’s disease , including cognitive issues such as memory loss, problem-solving, and speech problems, and movement concerns including lack of coordination, frequent falls, and tremors.

There is currently no cure for dementia with Lewy bodies. Medications and therapies such as occupational therapy , speech therapy, and psychological therapy can help treat disease symptoms.

Now, researchers from the Karolinska Institutet in Sweden have found that Alzheimer’s disease medications called cholinesterase inhibitors may help slow down cognitive decline in people with dementia with Lewy bodies over five years.

In this new study published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association , scientists also reported that the use of cholinesterase inhibitors was linked with a reduced mortality risk in the first year after a Lewy body dementia diagnosis.

Could cholinesterase inhibitors help treat Lewy body dementia?

For this study, researchers analyzed data from more than 1,000 people diagnosed with dementia from Lewy bodies from the Swedish Registry on cognitive/dementia disorders .

All study participants were prescribed one of two common treatments for Alzheimer’s disease or no treatment at all. The first treatment was a cholinesterase inhibitor called donepezil, and the second treatment was memantine . All participants were diagnosed and started treatment within three months of diagnosis and were followed for up to 10 years.

Cholinesterase inhibitors are used to prevent the breakdown of acetylcholine, a neurochemical important for memory and thinking skills, in nerve cells .

Memantine is prescribed to treat memory loss, which is a primary symptom of Alzheimer’s disease. Alzheimer’s disease negatively impacts nerve cells, causing them to create too much of a chemical called glutamate . Memantine blocks the effects of too much glutamate, offering protection to nerve cells.

“There are currently no approved treatments for dementia with Lewy bodies, so doctors often use drugs for Alzheimer’s disease, such as cholinesterase inhibitors and memantine, for symptom relief,” Hong Xu, PhD , assistant professor in the Department of Neurobiology, Care Sciences and Society a t the Karolinska Institutet in Sweden and first author of this study says in a press release . “However, the effectiveness of these treatments remains uncertain due to inconsistent trial results and limited long-term data.”

Using Alzheimer’s drugs to slow cognitive decline in Lewy body dementia

Upon analysis, researchers found that the use of cholinesterase inhibitors significantly slowed cognitive decline in participants with dementia with Lewy bodies over a five-year period, compared to those prescribed memantine or no treatment.

Additionally, scientists linked taking cholinesterase inhibitors with a reduced risk of death in the first year after a Lewy body dementia diagnosis. However, this mortality effect was not sustained after one year in participants with dementia with Lewy bodies.

“Our results highlight the potential benefits of cholinesterase inhibitors for patients with dementia with Lewy bodies and support updating treatment guidelines,” Maria Eriksdotter, PhD , professor in the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet and last author of the paper, comments in a press release .

Study findings add to existing clinical evidence

After reviewing this study, Karen D. Sullivan, PhD, ABPP , creator of I CARE FOR YOUR BRAIN, and Reid Healthcare Transformation Fellow for The Foundation of FirstHealth, told MNT it’s great to see proof of something in a scientific journal that she has seen clinically for years.

“Because there are no FDA approved medications for Lewy body dementia, many medical providers have needed to go for off label prescription management of the condition which has included cholinesterase inhibitors,” Sullivan explained. “I’ve seen them help many of my Lewy body patients and in some cases they seem even more helpful than in Alzheimer’s disease, the diagnosis they are FDA approved for.”

“Lewy body dementia is quite prevalent, probably the most underdiagnosed subtype of dementia and with no current FDA approved medications to slow or help manage symptoms we are in desperate need of new treatment options,” she continued. “The next step in this line of research would be to more closely look at the clinical population examined. Are there any other reasons that this group may have shown cognitive benefit aside from the pharmacological intervention? Specifically, lifestyle factors are most important to examine.”

Further research needed in other populations

MNT also spoke with David Merrill, MD, PhD , a board certified geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA, and Singleton Endowed Chair in Integrative Brain Health, about this study.

“In our specialty memory clinic, we already routinely prescribe cholinesterase inhibitors to patients diagnosed with Lewy Body Disease and related dementias,” Merrill said. “It’s good that this robust observational data is in agreement with our current practice. Such findings help spread the word to primary care clinics and to families directly that these drugs can significantly benefit DLB patients.”

“Similar cohort databases from other populations can likely be studied in the same manner,” he added. “It’d be interesting to see if these benefits are observed in other populations in Europe, the U.S., and other countries.”