To the Editor: Dementia with Lewy bodies (DLB) has been recognized as a major cause of dementia in elderly people, accounting for 10% to 15% of cases at autopsy.1 Visual hallucinations, typically well formed and detailed, are one of the core features of DLB,1-3 often resulting in increased caregiver burden. A therapeutic option for visual hallucinations in DLB patients is limited because traditional neuroleptic agents can provoke neuroleptic sensitivity reactions.3-5 Recent evidence has suggested that acetylcholinesterase inhibitors may be beneficial in the treatment of the cognitive and psychiatric symptoms of DLB,6-10 although data are limited regarding their long-term effect. Herein two cases of probable DLB with recurrent visual hallucinations are reported. After an acetylcholinesterase inhibitor became ineffective in these patients, a selective serotonin reuptake inhibitor resulted in a dramatic effect on visual hallucinations. An 80-year-old woman had a 3-year history of cognitive decline with a more recent onset of vivid, well-formed hallucinations. She reported seeing her late husband, her grandchildren, or unknown people and would talk to them. She showed pronounced variations in attention, alertness, and level of confusion but did not exhibit parkinsonism. Her baseline Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores were 25 and 5, respectively. After 2 weeks of treatment with donepezil (5 mg, the maximum dose permitted in Japan), there was a marked reduction in visual hallucinations, and after 4 weeks, she complained of no hallucinations, although at 12 months after treatment, she sometimes reported hallucinations again, and at 14 months, her hallucinations became as frequent and severe as before the treatment. Administration of haloperidol (0.75 mg) or risperidone (0.5 mg) had no effects on hallucinations but resulted in sedation and confusion; after administration of paroxetine (20 mg) for 4 weeks, her hallucinations disappeared completely. This effect has persisted to the present (14 months). A 77-year-old man presented with progressive cognitive decline, recurrent visual hallucinations, and parkinsonism. His baseline MMSE and GDS scores were 11 and 5, respectively, and he demonstrated behavioral abnormalities including hallucinations, apathy, and disinhibition. Four weeks of treatment with donepezil (5 mg) resulted in marked improvement; he had no hallucinations and showed interest in several activities, but at 7 months after the treatment, he became apathetic again, and at 14 months, visual hallucinations recurred. Ten mg of paroxetine was started, and after 6 weeks, hallucinations completely disappeared. The effect of paroxetine on hallucinations has persisted to the present (12 months), although he gradually declined in activity of daily living function because of worsening of parkinsonism. These two cases suggested that donepezil may be effective in treating hallucinations associated with DLB, but its effect may not persist for a long period, and paroxetine may be beneficial in the treatment of hallucinations in DLB patients even after donepezil becomes ineffective. The results are preliminary but deserve more-comprehensive investigation, and clinicians should be aware of the benefit of selective serotonin reuptake inhibitors in the treatment of visual hallucinations associated with DLB.