Lewy Body Dementia Treatment: What Helps Now, and What’s in Clinical Trials

Lewy body dementia (LBD) is one of the most common types of dementia, affecting an estimated 1.4 million people in the U.S. It accounts for 20 to 30 percent of all dementia cases. Yet unlike Alzheimer’s disease, there are still no FDA-approved treatments that can slow, stop, or reverse the disease.

That doesn’t mean there’s no help available. Doctors can manage the symptoms of LBD with a combination of medications, lifestyle strategies, and supportive care. And while clinical trials for Lewy body dementia are fewer than those for Alzheimer’s, there are a handful of promising drugs currently in the pipeline.

Here’s what to know about Lewy body dementia treatments available now — and what’s coming next.

Treatments for Lewy body dementia

Even though there aren’t disease-modifying treatments yet, doctors often prescribe existing medications to help with the cognitive, movement, and sleep problems that come with LBD. Talk to your doctor about whether these drugs are right for you. 

Treating LBD’s cognitive and memory symptoms

Cholinesterase inhibitors approved for Alzheimer’s — including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) — are commonly prescribed to help with the fluctuating thinking and memory issues in LBD. Rivastigmine is even FDA-approved for Parkinson’s disease dementia, one of two distinct types of Lewy body dementia.

Another Alzheimer’s drug, memantine (Namenda), is sometimes added to the mix, but on its own it doesn’t appear to be as effective for people with LBD.

Treating LBD’s movement symptoms

Many people with LBD experience tremors, muscle stiffness, balance problems, and other Parkinson’s-like movement symptoms. These can sometimes be treated with Parkinson’s medications such as carbidopa-levodopa.

However, these drugs can come with trade-offs. At higher doses, they may increase the risk of hallucinations, confusion, or other psychiatric side effects.

A surgical treatment called deep brain stimulation has been shown to help people with Parkinson’s disease, but it isn’t recommended for those who have already developed dementia.

https://beingpatient.com/what-is-deep-brain-stimulation-parkinsons-alzheimers/

Treating LBD’s sleep symptoms

One of the hallmark early symptoms of Lewy body dementia is REM sleep behavior disorder (RBD), where people physically act out their dreams — sometimes violently. Doctors usually recommend melatonin as the first-line treatment, since it’s generally safe and well tolerated.

Medications to avoid for people living with Lewy body dementia

Some drugs that are safe for other conditions can be dangerous for people with Lewy body dementia. For example, certain antipsychotics, anticholinergic drugs, sedatives, opioids, and over-the-counter sleep aids (like Advil PM) can cause severe side effects, including sudden worsening of symptoms — and in some cases, they may even be fatal.

That’s why it’s so important to work closely with a neurologist who has experience treating LBD.

Neurologists recommend against using these drugs: 

• antipsychotics
• anticholinergic drugs
• benzodiazepines and other sedatives
• opaiates  
• over-the-counter sleep aids 

Lifestyle interventions doctors recommend for people living with LBD

While research is still limited, some studies suggest that lifestyle changes may help manage symptoms in the early stages of LBD. This includes:

• Regular exercise to support mobility and brain health
• Cognitive activities like reading, puzzles, or games to keep the mind active
• Healthy eating patterns, such as the Mediterranean or DASH diet

Some studies suggest these lifestyle interventions could help with symptoms in the early stages of LBD, though more research is needed to know for sure. 

Experimental treatments for Lewy body dementia

Researchers are testing new drugs that could eventually become the first approved treatments for Lewy body dementia. A few in the spotlight include:

• Memantine (Phase 3 COBALT trial): Studying whether adding memantine to cholinesterase inhibitors provides extra benefit. Results are still pending.
• Nilotinib: Originally a leukemia drug, it may help the brain clear toxic proteins. Early results from a small Phase 2 trial were promising, but no Phase 3 trial is yet planned.
• Zervimesine (CT1812): Designed to prevent protein clumping in brain cells. Phase 2 results were encouraging, and the drug is now available through an expanded access program.
• Neflamapimod: A pill targeting brain inflammation. Its last trial didn’t meet goals, failing to slow cognitive impairment, but a Phase 3 trial is expected to launch in 2026.

What can be done about Lewy body dementia?

For now, LBD treatments focus on managing symptoms rather than changing the course of the disease. But research is moving forward, and new therapies are on the horizon.

If you or a loved one has been diagnosed with LBD, it’s important to talk with a doctor who understands the disease and can tailor treatment to your specific symptoms and stage of progression.

Ready to dig deeper? Explore our LBD interactive learning guide here.

Frequently asked questions about Lewy body dementia treatments

What is LBD?

Lewy body dementia (LBD) is the second most common form of dementia after Alzheimer’s disease. It accounts for about 20 to 30 percent of dementia cases in the U.S. and affects thinking, memory, movement, and sleep. There are currently no FDA-approved treatments that can slow or stop LBD, but doctors can manage symptoms with medications, lifestyle changes, and supportive care.

What are the stages of Lewy body dementia?

Lewy body dementia typically progresses through early, middle, and late stages. Early symptoms may include REM sleep behavior disorder (acting out dreams), mild memory problems, and changes in attention. As the disease progresses, movement symptoms similar to Parkinson’s and more severe cognitive decline appear. In late stages, people may need full-time care.

What medications are used to treat Lewy body dementia symptoms?

Doctors often prescribe Alzheimer’s medications such as rivastigmine (Exelon), donepezil (Aricept), or galantamine (Razadyne) to help with memory and thinking problems. Parkinson’s medications like carbidopa-levodopa may ease movement issues, though they can sometimes worsen hallucinations or confusion. Melatonin is often used to manage sleep problems such as REM sleep behavior disorder.

Which medications should people with LBD avoid?

Certain drugs can be harmful for people with LBD. These include antipsychotics, anticholinergic drugs, benzodiazepines, opioids, and many over-the-counter sleep aids. These medications can worsen symptoms — and in some cases may be life-threatening. Always consult a neurologist experienced in treating LBD before starting or changing medications.

Are there lifestyle changes that help with LBD?

Yes. While more research is needed, evidence suggests that exercise, cognitive activities like puzzles and reading, and healthy eating patterns such as the Mediterranean or DASH diet may support brain health and help manage early symptoms.

What new treatments for Lewy body dementia are being studied?

Several experimental drugs are in clinical trials, including:

• Memantine (Phase 3 trial): being studied in combination with cholinesterase inhibitors.

• Nilotinib: a leukemia drug that may help clear toxic proteins in the brain.

• Zervimesine (CT1812): designed to block harmful protein clumping.

• Neflamapimod: targeting brain inflammation, with a Phase 3 trial expected in 2026.

While none are yet approved, researchers are optimistic that the first disease-modifying treatment for Lewy body dementia could be on the horizon.