Lewy body dementia (LBD) is a form of dementia that results from a buildup of alpha-synuclein protein in the brain. This buildup forms deposits called Lewy bodies in the nerves that negatively affect normal brain function and behavior. The disease is devastating, with an average life expectancy of only five to eight years after diagnosis. Furthermore, LBD has no approved treatment worldwide except in Japan, where a medication called donepezil is used to alleviate symptoms. It is not used elsewhere due to the lack of comprehensive studies on the drug for dementia, making this condition even more difficult for patients in most locations. Thankfully, a new study has provided more support for using drugs known as cholinesterase inhibitors (ChEIs), including donepezil, in dementia treatment.
Lewy body dementia is devastating – not just for the patient, but also for their caretaker(s).
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ChEIs are medications traditionally used to treat certain forms of dementia. They inhibit cholinesterase, a protein that breaks down the neurotransmitter (chemical messenger) acetylcholine. Stopping acetylcholine from being broken down increases acetylcholine levels in the brain, improving memory and brain function. Because dementia drastically deteriorates memory and cognition, it is no wonder that ChEIs are used to treat this condition. However, because ChEIs traditionally treat Alzheimer’s and Parkinson’s disease, the discovery of their effectiveness with LBD is an exciting and very promising treatment method for researchers to look into. The complexities and inaccuracies of LBD diagnosis have made it difficult to find treatments, so any new discoveries are incredibly meaningful.
One explanation for the positive impact of ChEIs on LBD symptoms involves the cholinergic system—a network of nerves that communicate using acetylcholine. LBD patients often have impaired cholinergic systems, which ChEIs may help restore. Recent studies have discovered that ChEIs can not only slow cognitive decline in LBD patients but even improve brain function after just three months of usage. In addition, a study has found that using ChEIs reduces the risk of mortality in LBD patients, possibly because ChEIs improve brain function, which itself can reduce mortality. That being said, the risk is reduced only within the initial year and not after, for reasons that remain unclear.
This discovery of the efficacy of ChEIs for LBD treatment could be groundbreaking for dementia healthcare, given the scarce treatment options in most countries resulting from factors like poor understanding of how LBD works, misdiagnosis, and limited research funding. While future research will be needed to verify these findings before existing treatment guidelines are revised, if cholinesterase inhibitors can indeed improve LBD symptoms, this could be the glimmer of hope patients have been waiting for.
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