Given the marked cholinergic deficiency in DLB, it is not surprising that DLB patients can show marked improvement when treated with cholinesterase inhibitors. Improvements in hypersomnolence, attentional impairment, apathy, psychosis, and agitation have been noted in DLB patients treated with cholinesterase inhibitors (McKeith, 2002).

Because depression and psychosis are common in DLB, antidepressants and anti-psychotic medications are often needed. In prescribing antipsychotic medications, physicians should keep in mind the marked neuroleptic sensitivity characteristic of DLB (McKeith et al., 1992a) and use minimal doses of agents with low affinity for D2 receptors such as clozapine. Ondansetron, a 5HT-3 receptor antagonist, may be a valid alternative approach to the treatment of psychosis in DLB patients (Perry et al., 1993). Given their significant side effects, the usefulness of dopaminergic agents in the treatment of DLB is unclear. If these agents are used, they should be initiated in small doses, and the patient should be observed for confusion and psychosis.

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