Lewy body dementia (LBD) is asynucleinopathy that results in clinical manifestation of motor and neuropsychiatric symptoms. The disease burden associated with psychosis in LBD patients is significantly higher compared to other types of dementia or even to LBD without psychosis. Effective care management processes should include consideration of de-prescribing any offending agents including anticholinergics and dopaminergic agents, followed by nonpharmacological and low risk pharmacological approach. If addition of pharmacological agents is required, consideration should be given to acetylcholinesterase inhibitors, pimavanserin and atypical antipsychotics such as quetiapine or clozapine. Side effects of these medications should be considered prior to selection and initiation of a medication regimen. Goals of care and functional assessment are a crucial part of the optimized care plan, given overall guarded prognosis, in the context of numerous complications observed in this population. Palliative care consultation could facilitate symptom control and timely enrollment into hospice if consistent with patient’s goals.

路易体痴呆 (LBD) 是导致运动和神经精神症状临床表现的无核蛋白病。与其他类型的痴呆或什至没有精神病的 LBD 相比，LBD 患者与精神病相关的疾病负担明显更高。有效的护理管理过程应包括考虑取消任何违规药物的处方，包括抗胆碱能药物和多巴胺能药物，然后采用非药物和低风险药物方法。如果需要添加药物，应考虑使用乙酰胆碱酯酶抑制剂、匹马万色林和非典型抗精神病药如喹硫平或氯氮平。在选择和开始用药方案之前，应考虑这些药物的副作用。在该人群中观察到许多并发症的情况下，考虑到总体谨慎的预后，护理和功能评估的目标是优化护理计划的关键部分。如果符合患者的目标，姑息治疗咨询可以促进症状控制和及时进入临终关怀。