From Symptom Management to Disease Modification: The Evolving Therapeutic Landscape of Dementia with Lewy Bodies

Abstract

People with Dementia with Lewy bodies (DLB) have a complex clinical presentation, with symptoms spanning cognitive, neuropsychiatric, motor, autonomic, and sleep domains. The disorder causes high morbidity and high caregiver burden, and can also result in increased healthcare costs. Although symptomatic treatments remain limited, emerging evidence supports a multipronged approach integrating pharmacological and non-pharmacological interventions targeting different signs and symptoms. Novel frameworks, such as the DIAMOND Lewy toolkit, provide structured management guidance. Beyond symptom control, DLB research is at a turning point with increasing focus on disease modification. Ongoing clinical trials are exploring diverse therapeutic targets, including α-synuclein aggregation and neuroinflammation pathways. Amyloid may also be a tractable target in DLB given Alzheimer’s disease co-pathology is common in older patients with DLB.