Cholinesterase inhibitors may slow cognitive decline in dementia with Lewy bodies

Dementia with Lewy bodies is a form of dementia similar to both Alzheimer’s disease and Parkinson’s disease, but studies on long-term treatments are lacking. A new study from the Karolinska Institutet in Sweden, published in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Associationhighlights the potential cognitive benefits of cholinesterase inhibitor treatment.

Lewy body disease, which includes dementia with Lewy bodies (DLB) and Parkinson’s disease with and without dementia, is the most common neurodegenerative disorder after Alzheimer’s disease. DLB accounts for approximately 10-15 percent of dementia cases and is characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic body functions.

There are currently no approved treatments for DLB, so doctors often use Alzheimer’s medications, such as cholinesterase inhibitors and memantine, to relieve symptoms. However, the effectiveness of these treatments remains uncertain due to inconsistent research results and limited long-term data.”

Hong Xu, assistant professor at the Department of Neurobiology, Healthcare Sciences and Society, Karolinska Institutet and first author of the article

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

“Our results highlight the potential benefits of ChEIs for patients with DLB and support updating treatment guidelines,” says Maria Eriksdotter, professor at the Department of Neurobiology, Healthcare Sciences and Society, Karolinska Institutet and last author of the paper.

Due to the observational nature of the study, no conclusions can be drawn about causality. The researchers did not have data on patients’ lifestyle habits, frailty, blood pressure and co-pathology of Alzheimer’s disease, which may have influenced the findings. Another limitation of the study is that it remains a challenge to accurately diagnose DLB.

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