Résumé of treatment workshop sessions

Summary

Contributors to the chapters on treatment issues met together with other interested participants in the Workshop (Owen Collins, Alan Cross, Murat Emre, Ernst Jansen, Amos Korczyn, John O'Brien, Arjun Sahgal, and Peter Thompson) for a morning discussion of key areas relating to therapy. The group explored the biological basis for four symptom clusters in dementia with Lewy bodies (DLB): psychosis, cognitive deficits, affective and motor disorders. An important issue relating to therapy was considered to be the nature and extent of interactions between these different symptoms and the way in which they vary with time. Therapeutic strategies were discussed from several viewpoints: in terms of clinical experience with currently available Pharmaceuticals in treating these symptoms in other disorders; anecdotal experience with DLB patients; and theoretically based hypothesis-driven designs for future treatment. The group concentrated on neurotransmitter-orientated intervention since this was considered the most immediately relevant in relation to symptoms (neuroleptics or cholinergics for psychosis or dementia). It was appreciated that in the longer term, with increased understanding of aetiology and development of new preventative or neuroprotective approaches, therapeutic objectives would expand beyond the symptomatic range. Examples of such strategies include the potential of neurotrophins (Chapter 35) or antioxidants (Chapter 36).

The hypothesis that psychotic features such as hallucinations in DLB are associated with depleted neocortical cholinergic activities (Chapters 30 and 31) was considered in the light of present preliminary and conflicting evidence on the effects of anticholinesterases. Most of this evidence is based on trials of tacrine in clinically diagnosed cases of Alzheimer's disease (AD) which inevitably include some cases of DLB.