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Management Guideline for Lewy Body Dementia

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Management Guideline for Lewy Body Dementia Management Guideline for Lewy body dementia © 2019 Newcastle University 1 Version 3.0 Date 08.10.2019 Management guideline development John-Paul Taylor, Professor of Translational Dementia Research, Newcastle University Ian McKeith, Professor of Old Age Psychiatry, Newcastle University John O'Brien, Professor of Old Age Psychiatry, University of Cambridge 2 Version 3.0 Date 08.10.2019 Disclaimer All the information and advice on within this guideline and associated summary sheets (collectively known as the Lewy body dementia (LBD) management toolkit) has been assembled to the best of our knowledge. The LBD management toolkit is intended for information and use by healthcare professionals only and not intended to be a substitute for independent professional medical advice, diagnosis or treatment. Information and advice provided in the LBD management toolkit does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer. Health care professional users of the LBD management toolkit are wholly responsible for the care of their patient’s medical care, treatment and oversight. Although the greatest possible care has been taken in compiling the LBD management toolkit, we cannot guarantee that all the information provided within the LBD management toolkit is accurate. Newcastle University and Diamond-Lewy team assume no liability for the accuracy of the contents of the LBD management toolkit and will not be held responsible for any loss, damage or inconvenience caused as a result of any inaccuracy or error within the LBD management toolkit. Newcastle University and the Diamond-Lewy team also assume no liability for the contents and their accuracy on any third party websites that are accessible through links via the LBD management toolkit. These links are provided purely for your convenience, and do not imply that Newcastle University or the Diamond-Lewy team support the information given on those pages. Copyright statement These materials are copyright of Newcastle University except where otherwise stated. You are not permitted to alter, amend or convert these materials without prior permission of the copyright owners. However these permissions/consent shall not be unreasonably withheld and we actively support and encourage uptake, use and adaption of the toolkit. How to reference this guideline Taylor, J-P., McKeith, IG. O’Brien, JT. Management Guideline for Lewy body dementia. (2019). Available online: https://research.ncl.ac.uk/diamondlewy/managementtoolkit/ Funding This study/project was funded by the National Institute for Health Research (NIHR) [DTC-RPPG- 0311-12001]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. 3 Version 3.0 Date 08.10.2019 Contents Contents .................................................................................................................................... 4 Part 1 Background ...................................................................................................................... 6 Development of this Guideline ...................................................................................................................... 6 Establishment of the existing evidence base in LBD ................................................................................. 6 Public-patient workshops .......................................................................................................................... 6 Drafting of guidelines and Delphi consensus ............................................................................................ 7 Piloting in a clinical study .......................................................................................................................... 7 Part 2 How to use this document ............................................................................................... 9 References ..................................................................................................................................................... 9 Part 3 Basic principles of LBD management ............................................................................... 10 Principles of management - general recommendations .............................................................................. 10 Use of medication ........................................................................................................................................ 10 Use of medication - general recommendations .......................................................................................... 11 Part 4 Managing cognitive symptoms ........................................................................................ 12 Managing cognitive symptoms - general recommendations ....................................................................... 12 Medications ................................................................................................................................................. 12 Cholinesterase inhibitors ......................................................................................................................... 12 Memantine .............................................................................................................................................. 14 Part 5 Managing neuropsychiatric symptoms ............................................................................ 15 Managing neuropsychiatric symptoms - general recommendations .......................................................... 15 Hallucinations and delusions ....................................................................................................................... 15 Hallucinations and delusions - treatment recommendations ..................................................................... 15 Antipsychotic prescribing in LBD.................................................................................................................. 16 Agitation and aggression - treatment recommendations ............................................................................ 16 Apathy - treatment recommendations ........................................................................................................ 17 Depression and anxiety - treatment recommendations .............................................................................. 17 Part 6 Managing Parkinsonian symptoms .................................................................................. 18 General principles for the management of Parkinsonian symptoms in dementia with Lewy bodies ......... 18 Managing Parkinsonian symptoms in dementia with Lewy bodies - treatment recommendations. .......... 18 General principles for the management of Parkinsonian symptoms in Parkinson’s disease with dementia ..................................................................................................................................................................... 18 Managing Parkinsonian symptoms in Parkinson’s disease with dementia - treatment recommendations 18 Part 7 Managing autonomic dysfunction .................................................................................. 20 Orthostatic hypotension - general principles .............................................................................................. 20 Orthostatic hypotension - treatment recommendations ............................................................................ 20 Non-pharmacological management strategies ....................................................................................... 20 Pharmacological management strategies ............................................................................................... 20 Gastroparesis- treatment recommendations .............................................................................................. 21 Constipation - treatment recommendations ............................................................................................... 21 Urinary dysfunction and incontinence - treatment recommendations ....................................................... 22 Male sexual dysfunction - treatment recommendations ............................................................................ 22 Excessive sweating - treatment recommendations ..................................................................................... 22 Sialorrhoea and dysphagia - treatment recommendations ......................................................................... 23 Part 8 Managing sleep disturbances ..................................................................................... 24 4 Version 3.0 Date 08.10.2019 General principles ........................................................................................................................................ 24 Insomnia and sleep fragmentation .............................................................................................................. 24 REM-Sleep behaviour disorder (RBD) .......................................................................................................... 24 Motor-related sleep disturbances ............................................................................................................... 25 Restless legs syndrome and periodic limb movements ..............................................................................
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