# Dementia with Lewy bodies

Source: https://onco.cc/diagnoses/dementia-with-lewy-bodies/  
OnCo record `dementia-with-lewy-bodies` (Diagnosis). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Dementia with Lewy bodies often mixes thinking changes with fluctuating alertness, visual hallucinations, sleep-acting-out, and movement symptoms. Antipsychotics can cause severe sensitivity reactions.

## Summary

Lewy body disease involves alpha-synuclein aggregates. Dementia with Lewy bodies is diagnosed when dementia begins before or around the same time as parkinsonism. Care is tailored to cognition, movement, sleep, hallucinations, and blood-pressure changes. Rivastigmine has an FDA indication for Parkinson’s disease dementia, not a disease-modifying Lewy body treatment. There is no FDA disease-modifying treatment for dementia with Lewy bodies.

## Fields

- Kind: Diagnosis
- Last checked: 2026-09-21
- Tags: dementia-atlas
- Group: dementia
- Biomarkers: Clinical features (fluctuation, hallucinations, REM sleep behaviour, parkinsonism); Dopamine transporter imaging in selected cases

## Standard of care

- Care, not disease modification: Review medicines that worsen confusion or blood pressure. Consider rivastigmine where indicated. Avoid antipsychotics unless a clinician experienced in Lewy body disease judges the risk unavoidable. ([Rivastigmine](https://onco.cc/drugs/da-rivastigmine/))

## Open problems

- Misdiagnosis as psychiatric disease or typical Alzheimer’s disease remains common.
- Antipsychotic sensitivity is still under-recognised in general settings.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Dementia_with_Lewy_bodies
- Alzheimer’s Association: dementia with Lewy bodies: https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies

## Connected records

- diagnoses: [Dementia (umbrella)](https://onco.cc/diagnoses/dementia/), [Parkinson’s disease dementia](https://onco.cc/diagnoses/parkinsons-disease-dementia/)
- fronts: [Symptomatic care](https://onco.cc/fronts/da-front-symptomatic-care/)
- technologies: [Cholinesterase inhibitors](https://onco.cc/technologies/da-tech-cholinesterase-inhibitors/)
- targets: [Acetylcholinesterase](https://onco.cc/targets/da-target-ache/), [Alpha-synuclein](https://onco.cc/targets/da-target-alpha-synuclein/)
- drugs: [Rivastigmine](https://onco.cc/drugs/da-rivastigmine/)
- bottlenecks: [Wrong-subtype treatment](https://onco.cc/bottlenecks/da-bn-subtype-misclassification/)

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