Dementia with Lewy bodies is a type of dementia that is similar to both Alzheimer’s disease and Parkinson’s disease but studies on long-term treatments are lacking. A new study from Karolinska Institutet, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, highlights the potential cognitive benefits of cholinesterase inhibitor treatments such as Aricept, also known generically as donepezil.
Lewy body disease, which includes dementia with Lewy bodies (DLB) and Parkinson’s disease with and without dementia, is the second most common neurodegenerative disorder, following Alzheimer’s disease.
DLB accounts for approximately 10–15 per cent of dementia cases and is characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions.
“There are currently no approved treatments for DLB, so doctors often use drugs for Alzheimer’s disease, such as cholinesterase inhibitors and memantine, for symptom relief,” says Hong Xu, assistant professor at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and first author of the paper. “However, the effectiveness of these treatments remains uncertain due to inconsistent trial results and limited long-term data.”
In the current study, researchers have 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.
Slower cognitive decline
They found that ChEIs may slow down 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, Care Sciences and Society, Karolinska Institutet and last author of the paper.
Due to the study’s observational nature, no conclusions can be drawn about causality. The researchers did not have data on patient lifestyle habits, frailty, blood pressure, and Alzheimer’s disease co-pathology, which may have influenced the findings. Another limitation of the study is that it remains challenging to diagnose DLB accurately.
The research was mainly financed by StratNeuro, the Center for Innovative Medicine (CIMED), the KI foundations and the Swedish Research Council.
Publication
“Long-Term Effects of Cholinesterase Inhibitors and Memantine on Cognitive Decline, Cardiovascular Events, and Mortality in Dementia with Lewy Bodies: An up to 10-Year Follow-Up Study”, Hong Xu, Annegret Habich, Daniel Ferreira, Londos Elisabet, Eric Westman, Maria Eriksdotter, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, online 23 August 2024, doi: 10.1002/alz.14118.
ChEIs are designed to increase Choline (a neurotransmitter associated with memory). It is also possible to increase Choline with over the counter supplements (We’ve seen good results with a product developed by Dr Datis Kharrazian called Acetyl-CH-Active by Apex Energetics (and no, I have no financial relationship with Apex or Dr K). The challenge with all of the pharmaceutical CheIs is the common side-effects of sleep disruption and stomach pain. The one exception is the Exelon Patch, which messes with sleep but not the stomach. These drugs have been very disappointing with Alzheimer’s Disease – many of my AD patients have had improved quality of life after Donepezil was stopped (and sleep improved). It’s exciting that these drugs may be effective for LBD. I would love to see a study on Choline supplements but that is unlikely without a patent.
Thanks Matt for those insights. Better than choline supplements may be dietary choline. Learn about it in this article and video post:
Rosemary Emulates Aricept & Donepezil
Thanks for sharing – that is a great article!