Alzheimer's drug could slow progression of Lewy body dementia

Lewy body disease, particularly Lewy body dementia (DLB), affects a significant proportion of dementia patients and is characterized by a range of symptoms, including sleep disorders and cognitive impairment.

Recent research at Karolinska Institutet investigated the long-term effectiveness of cholinesterase inhibitors and memantine in treating DLB. The study, which included over a thousand patients, suggests that cholinesterase inhibitors not only slow cognitive decline over five years but also reduce the risk of death in the first year after diagnosis, although these observations are limited by the non-experimental design of the study.

Lewy body disease, which also includes Lewy body dementia (DLB) and Parkinson’s disease with and without dementia, is the second most common neurodegenerative disease after Alzheimer Disease. DLB accounts for about 10–15 percent of dementia cases and is characterized by changes in sleep, behavior, perception, movement, and regulation of automatic body functions.

Treatment challenges in DLB

“There are currently no approved treatments for DLB, so doctors often use anti-Alzheimer's drugs such as cholinesterase inhibitors and memantine to relieve symptoms,” says Hong Xu, assistant professor at the Department of Neurobiology, Nursing Sciences and Society at Karolinska Institutet and lead author of the study. “However, the effectiveness of these treatments remains uncertain due to inconsistent study results and limited long-term data.”

Research results on DLB treatments

In the current study, researchers examined the long-term effects of cholinesterase inhibitors (ChEIs) and memantine compared with no treatment over up to ten years in 1,095 patients with DLB. They found that ChEIs can slow cognitive decline over five years compared with memantine or no treatment. ChEIs were also associated with a reduced risk of death in the first year after diagnosis.

“Our results underline the potential benefit of ChEIs for patients with DLB and support an update of treatment guidelines,” says Maria Eriksdotter, professor at the Department of Neurobiology, Nursing Sciences and Society at Karolinska Institutet and last author of the study.

Limitations of the study and future directions

Because the study is observational, no conclusions can be drawn about causality. The researchers did not have data on patients' lifestyle habits, frailty, blood pressure, and Alzheimer's copathology, which may have influenced the results. Another limitation of the study is that it remains difficult to accurately diagnose DLB.

Reference: “Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: A follow-up study up to 10 years” by Hong Xu, Annegret Habich, Daniel Ferreira, Londos Elisabet, Eric Westman, and Maria Eriksdotter, August 23, 2024, Alzheimer's and Dementia: The Journal of the Alzheimer's Association.
DOI: 10.1002/alz.14118

The research was mainly funded by StratNeuro, the Centre for Innovative Medicine (CIMED), the AI ​​Foundations and the Swedish Research Council.