The recent review by Taylor et al. in Lancet Neurology addresses the complexities of managing Lewy body dementia (LBD), which encompasses both dementia with Lewy bodies and Parkinson's disease dementia. The authors emphasize the diverse symptoms associated with LBD-including cognitive, neuropsychiatric, motor, autonomic, and sleep disturbances-which often fluctuate, complicating patient management. They underscore the difficulty of treating these symptoms in isolation, as addressing one can exacerbate others. Additionally, Taylor and colleagues highlight the fragmented care LBD patients frequently receive due to specialist segmentation.

The review covers the use of cholinesterase inhibitors (such as donepezil and rivastigmine) and memantine in managing cognitive symptoms, noting their relative efficacy and limitations. Neuropsychiatric symptoms, including hallucinations, delusions, and depression, are prevalent in LBD, and although donepezil and rivastigmine can help, treatment options remain limited. Non-pharmacological interventions, while advocated, lack substantial supporting evidence for LBD specifically. The authors recommend an interdisciplinary approach to manage motor symptoms, especially given the commonality of falls and the use of levodopa and other dopaminergic medications.

Autonomic and sleep dysfunctions are prominent but under-studied aspects of LBD. The authors suggest that treatments for Parkinson's disease might offer insights, particularly for managing orthostatic hypotension and constipation. Non-pharmacological measures are advised for sleep disturbances, with melatonin and certain dopamine agonists as potential options. However, a lack of robust evidence emphasizes the need for further studies.

This review calls for more research on the unique challenges of LBD to establish a comprehensive and standardized approach to care, highlighting the potential for international collaborations to advance treatment and improve patient outcomes.