Behavioral and psychological symptoms in Lewy body disease: a review

Dementia with Lewy bodies (DLB) is a common neurodegenerative disease, second in terms of prevalence after Alzheimer's disease (AD). DLB may be suspected according to three core features which are cognitive and motor fluctuations, early visual hallucinations and parkinsonism; and more recently, according to the new criteria, REM sleep behavior disorder (RBD). Behavorial and psychological symptoms associated with DLB are more frequent, more severe and appear earlier than those found in other neurodegenerative diseases. They may be at the forefront and are a major diagnostic and therapeutic challenge. An improved knowledge of the pathophysiology and phenomenology associated to these symptoms can facilitate their identification as well as eliminating differential diagnoses. Managing these symptoms may require drugs when hallucinations are overwhelming and induce behavorial disorders. However, psychotropic medications are not well tolerated in this specific population and some antipsychotic drugs cannot be prescribed due to their side effects. Although further studies are needed on this subject, non-interventional treatments such as therapeutic strategies based on the patients and their caregivers appear to be essential. This paper offers a review which aims to help clinicians to identify behavioral and psychological symptoms in DLB and treat them in their daily practice.