2022 Alzheimer's Association Clinician Scientist Fellowship (AACSF)

A Pragmatic Randomized Trial Comparing Antipsychotics in Lewy Body Disease

Is there a medication that works better for individuals with Lewy body disease to address the hallucinations, illusions and/or delusions that some may experience?

Sarah Horn, M.D.
University of Texas Health Science Center
San Antonio, TX - United States

Background

Dementia with Lewy bodies  is a neurodegenerative disorder characterized by the presence of protein clumps in the brain known as Lewy bodies; the primary component of these clumps is a protein known as alpha synuclein. These features are also observed in some individuals with Alzheimer's and in most individuals with Parkinson's disease. 

Psychosis (experiencing hallucinations, illusions, and/or delusions) is highly prevalent among patients with Dementia with Lewy bodies and Parkinson’s disease, collectively referred to as Lewy body disease (LBD). Studies show that psychosis in LBD is associated with increased institutionalization rates and poorer quality of life for the individual living with the disease..

Currently there are no FDA drugs approved to treat the symptoms of psychosis in people living with LBD. Pharmaceutical treatment options are limited for psychosis in individuals with lewy bodies. Although two medicines, quetiapine and pimavanserin, are commonly used in clinical practice for psychosis, few studies have compared the use of these medicines for psychosis in LBD. 
 

Research Plan

Dr. Sarah Horn and colleagues will conduct the first head-to-head trial comparing pimavanserin to quetiapine for the treatment of psychosis in individuals with LBD. The study will include patients seen in the neurology clinic at UT Health San Antonio with a diagnosis of psychosis due to Parkinson’s disease or dementia with Lewy bodies requiring the initiation of an antipsychotic medication. The participants will be randomly assigned to pimavanserin or quetiapine and followed-up by the study team for at least six months. The research team will evaluate participants for psychotic symptoms and changes in mood, agitation, and sleep issues, as well as any adverse events.

Impact

The results of this study may help inform clinicians regarding treatment of psychosis in individuals with Parkinson’s disease or dementia with Lewy bodies. Managing symptoms of psychosis may benefit patients’ quality of life, as well as that of caregivers.