Abstract
Psychotic features, especially visual hallucinations and delusions are common in dementia with Lewy bodies (DLB). Treatment of psychotic features in DLB is complicated by a marked increase in the frequency and severity of side effects of neuroleptic treatment. Hence conventional neuroleptic drugs like haloperidol are contraindicated in DLB. Meta-analysis suggests that cholinesterase-inhibitors (ChE-I) are effective and safe in treatment for cognitive and non-cognitive symptoms in DLB. Unfortunately in a large proportion of DLB cases psychotic features do not respond to ChE-I treatment alone. Low-dose clozapine treatment is acknowleged usual practise for psychotic features in Parkinson's disease and data indicate efficacy in DLB too. Clozapine treatment needs special precautions. Treatment of parkinsonism in DLB patients may worsen psychotic features and should be limited to levodopa. Clinical diagnostic criteria have been improved in 2005, because the older criteria showed a low sensitivity
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